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Food allergy

  2. INTRODUCTION  Food allergy is an immune system reaction that occurs soon after eating a certain food. Even a tiny amount of the allergy-causing food can trigger signs and symptoms such as digestive problems, hives or swollen airways. In some people, a food allergy can cause severe symptoms or even a life-threatening reaction known as anaphylaxis.  Food allergy affects an estimated 6 to 8 percent of children under age 3 and up to 3 percent of adults. While there's no cure, some children outgrow their food allergy as they get older.  It's easy to confuse a food allergy with a much more common reaction known as food intolerance. While bothersome, food intolerance is a less serious condition that does not involve the immune system, and is triggered by several different mechanisms that are distinct from the immunological reaction responsible for food allergy.
  3. Food Allergy in India and Asia  Although we often think of allergy as a Western disease, in reality it’s fast becoming a global problem. In many Western nations, allergy rates stand at around 40% of the population – or sometimes higher. It may surprise you, but India is not far behind, with an estimated 25% of the population now having at least one allergic condition.  India, with a diverse and unique food culture, has acquired its own portfolio of allergens too. Granted, nuts and wheat and dairy and others can be a problem to south Asians, but research led by Professor Mahesh PA, Director at Allergy Asthma Associates in Mysore, India, has uncovered many others – with brinjal (aubergine), cucumber, lady’s finger (okra) and papaya among the most common foods causing clinical symptoms in population samples from Mysore City and from Bangalore.  With a population of well over a billion, food allergy could become an enormous problem in India. Some estimates suggest up to 3% of Indians may already have food allergies, the majority under 40 years of age. Food allergies cause roughly 30,000 emergency treatments and 100 to 200 deaths per year in the nation. Up to 3 million Indians may have peanut allergy alone.
  4. FOOD ALLERGY FACTS  Food allergy is not common but can be serious.  Food allergy differs from food intolerance, which is far more common.  The more frequent types of food allergies in adults differ from those in children.  Children can outgrow their food allergies, but adults usually do not.  The diagnosis of food allergy is made with a detailed history, the patient's diet diary, or an elimination diet.  Food allergy is treated primarily by dietary avoidance.
  5. MECHANISM OF ALLERGY The protein in the food is the most common allergic component. These kinds of allergies occur when the body's immune system mistakenly identifies a protein as harmful. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE). These tags fool the immune system into thinking that the protein is an invader. The immune system, thinking the organism (the individual) is under attack, sends white blood cells to attack, and that triggers an allergic reaction. These reactions can range from mild to severe. Allergic responses include dermatitis, gastrointestinal and respiratory distress, including such life- threatening anaphylactic responses as biphasic anaphylaxis and vasodilation; these require immediate emergency intervention. Individuals with protein allergies commonly avoid contact with the problematic protein. Some medications may prevent, minimize or treat protein allergy reactions. There is no cure.
  6. Classification Conditions caused by food allergies are classified into 3 groups according to the mechanism of the allergic response: 1. IgE-mediated (classic):  Type-I immediate hypersensitivity reaction  Oral allergy syndrome 2. IgE and/or non-IgE-mediated:  Allergic eosinophilic oesophagitis  Allergic eosinophilic gastritis  Allergic eosinophilic gastroenteritis 3. Non-IgE mediated:  Food protein-induced Enterocolitis syndrome (FPIES)  Food protein proctocolitis/proctitis  Food protein-induced enteropathy. An important example is Celiac disease, which is an adverse immune response to the protein gluten.  Milk-soy protein intolerance (MSPI) is a non-IgE mediated allergic response to milk and/or soy protein during infancy and early childhood. Symptoms of MSPI are usually attributable to food protein proctocolitis or FPIES.  Heiner syndrome — lung disease due to formation of milk protein/IgG antibody immune complexes (milk precipitins) in the blood stream after it is absorbed from the GI tract.
  7. What causes food allergies?  Food allergies are caused when the immune system (the body’s defence against infection) mistakenly treats proteins found in food as a threat to the body, when in fact they should be harmless.  It then releases a number of chemicals to prevent what it sees as an infection taking hold. It is these chemicals that cause the symptoms of an allergic reaction.  Any food could cause an allergic reaction, but there are certain foods that are responsible for most food allergies. In children, the foods that most commonly cause an allergic reaction are:  Milk  Eggs  Peanuts  Tree nuts  Fish and Shellfish  Wheat  Soy
  8. CHILD SYMPTOMS •Abdominal pain •Constipation •Cough •Decreased hearing •Diarrhea •Earache •Eye discomfort and redness •Fever •Headaches •Joint pain or muscle pain •Nasal congestion •Nausea or vomiting •Skin rashes •Sore throat •Urinary problems •Vision problems •Wheezing ADULT SYMPTOMS •Abdominal pain •Blood in stool •Chest pain •Constipation •Cough •Diarrhea •Difficulty swallowing •Dizziness •Eye discomfort and redness •Foot pain or ankle pain •Foot swelling or leg swelling •Headaches •Heart palpitations •Hip pain •Knee pain •Low back pain •Nasal congestion •Nausea or vomiting •Neck pain •Numbness or tingling in hands •Pelvic pain: female •Pelvic pain: male •Shortness of breath •Shoulder pain •Sore throat •Urinary problems •Vision problems •Wheezing
  9. PEANUT ALLERGY  Peanut allergies tend to be lifelong, although studies indicate that approximately 20 percent of children with peanut allergy do eventually outgrow their allergy  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  An estimated 25-40 percent of people who have peanut allergy also are allergic to tree nuts. In addition, peanuts and tree nuts often come into contact with one another during manufacturing and serving processes. For these reasons, allergists usually tell their patients with peanut allergy to avoid tree nuts as well.
  10. Avoiding Peanuts  The federal Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that all packaged food products sold that contain peanuts as an ingredient must list the word ―Peanut‖ on the label.  Read all product labels 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.
  11. Avoid foods that contain peanuts or any of these ingredients: Artificial nuts Beer nuts Cold pressed, expeller pressed or extruded peanut oil Goobers Ground nuts Mandelonas (peanuts soaked in almond flavoring) Mixed nuts Monkey nuts Nut meat Nut pieces Peanut butter Peanut flour Peanut protein hydrolysate Peanut is sometimes found in the following: Baked goods (e.g., pastries, cookies) Candy (including chocolate candy) Chili Egg rolls Enchilada sauce Marzipan Mole sauce Nougat
  12. TREE NUT ALLERGIES  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.
  13. Tree nuts are sometimes found in the following: Black walnut hull extract (flavoring) Natural nut extract Nut distillates/alcoholic extracts Nut oils (e.g., walnut oil, almond oil) Walnut hull extract (flavoring) 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. Since these beverages are not currently regulated by FALCPA, you may need to call the manufacturer to determine the safety of ingredients such as natural flavoring.
  14. MILK ALLERGY  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. Therefore it is advised that people with milk allergy have quick access to an epinephrine auto-injector (such as an EpiPen®, Auvi- Q® or Adrenaclick®) at all times. To prevent a reaction, strict avoidance of cow’s milk and cow’s milk products is essential.  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
  15. 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.
  16. Avoid foods that contain milk or any of these ingredients: Butter, butter fat, butter oil, butter acid, Buttermilk Casein Casein hydrolysate Caseinates (in all forms) Cheese Cottage cheese Cream Curds Custard Diacetyl Ghee Half-and-half Lactalbumin, lactalbumin phosphate Lactose Lactulose Milk Milk protein hydrolysate Pudding Rennet casein Sour cream, sour cream solids Sour milk solids Whey (in all forms) Whey protein hydrolysate Yogurt Milk is sometimes found in the following: Artificial butter flavor Baked goods Caramel candies Chocolate Lactic acid starter culture and other bacterial cultures Luncheon meat, hot dogs, sausages Margarine Nisin Nondairy products Nougat
  17. Some Unexpected Sources of Milk  Deli meat slicers are frequently used for both meat and cheese products.  Some brands of canned tuna fish contain casein, a milk protein.  Many non-dairy products contain casein (a milk derivative), listed on the ingredient labels.  Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.  Some meats may contain casein as a binder. Check all labels carefully.  Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions about the risk of milk contact when purchasing shellfish.  Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.  Some medications contain milk protein.
  18.  Egg 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.  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.
  19. 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.  Influenza vaccines usually contain a small amount of egg protein. If you or your child is allergic to eggs, speak to your doctor before receiving a flu shot.
  20. Avoid foods that contain eggs or any of these ingredients: Albumin (also spelled albumen) Egg (dried, powdered, solids, white, yolk) Eggnog Lysozyme Mayonnaise Meringue (meringue powder) Ovalbumin Surimi Eggs are sometimes found in the following: Baked goods Egg substitutes Lecithin Macaroni Marzipan Marshmallows Nougat Pasta •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. Read the label or ask about ingredients before eating pasta. •Egg wash is sometimes used on pretzels before they are dipped in salt. Some Unexpected Sources of Egg
  21. WHEAT ALLERGY 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, a nd tapioca. When baking with wheat-free
  22. Differences between Wheat Allergy and Celiac Disease or Gluten Intolerance  Celiac disease 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.
  23. Avoid foods that contain wheat or any of these ingredients: •Bread crumbs •Bulgur •Cereal extract •Club wheat •Couscous •Cracker meal •Durum •Einkorn •Emmer •Farina •Flour (all purpose, bread, cake, durum, enriched, graham, high gluten, high protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat) •Hydrolyzed wheat protein •Matzoh, matzoh meal (also spelled as matzo, matzah, or matza) •Pasta •Seitan •Semolina •Spelt •Sprouted wheat •Triticale •Vital wheat gluten •Wheat (bran, durum, germ, gluten, grass, malt, sprouts, starch) •Wheat bran hydrolysate •Wheat germ oil •Wheat grass •Wheat protein isolate •Whole wheat berries
  24. SOY ALLERGY  Soybean allergy is one of the more common food allergies, especially among babies and children. Approximately 0.4 percent of children are allergic to soy.  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.
  25. Avoid foods that contain soy or any of these ingredients: •Edamame •Miso •Natto •Shoyu •Soy (soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt) •Soya •Soybean (curd, granules) •Soy protein (concentrate, hydrolyzed, isolate) •Soy sauce •Tamari •Tempeh •Textured vegetable protein (TVP) •Tofu 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.
  26. FISH AND SHELLFISH ALLERGY  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.  There are two kinds of shellfish: crustacea (such as shrimp, crab and lobster) and molluscs (such as clams, mussels, oysters and scallops).
  27. Some Unexpected Sources of Fish  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
  28. 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) Shellfish are sometimes found in the following: Bouillabaisse Cuttlefish ink Glucosamine Fish stock Seafood flavoring (e.g., crab or clam extract) Surimi Keep the following in mind: •If you have seafood allergy, avoid seafood restaurants. Even if you order a non- seafood item off of the menu, cross-contact is possible. •Asian restaurants often serve dishes that use fish sauce as a flavoring base. Exercise caution or avoid eating there altogether. •Shellfish protein can become airborne in the steam released during cooking and may be a risk. Stay away from cooking areas. •Carrageenan, or "Irish moss,‖ is not shellfish. It is a red marine algae that is used in a wide variety of foods, particularly dairy foods, as an emulsifier, stabilizer, and thickener. It appears safe for most individuals with food allergies. •Allergy to iodine, allergy to radiocontrast material (used in some radiographic procedures), and to shellfish are not related. If you have an allergy to shellfish, you do not need to worry about cross reactions with radiocontrast material or iodine.
  29. OTHER ALLERGENS While only eight foods (milk, egg, peanut, tree nuts, fish, shellfish, wheat, and soy) account for approximately 90 percent of all food-allergic reactions, a person can be allergic to virtually any food.While the list below is not exhaustive, allergic reactions have been reported to: Corn Rice Vegetable Oil Spice Gelatin Meat (beef, chicken, mutton, and pork) Seeds (sesame, sunflower, and poppy being the most common) Spices (caraway, coriander, garlic, mustard, etc.) Other common causes of severe reactions include: Medications Latex Insect Stings Mushrooms 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.
  30. TREATMENT  The mainstay of treatment for food allergy is total avoidance of the foods that have been identified as allergens. For people who are extremely sensitive, avoidance includes avoiding touching or inhaling the problematic food.  If the food is accidentally ingested and a systemic reaction (anaphylaxis) occurs, then epinephrine should be used. It is possible that a second dose of epinephrine may be required for severe reactions. The person should then be transported to the emergency room, where additional treatment can be given.  Other treatments include: antihistamines, and steroids. In a severe case, neither steroids nor antihistamines are life saving and its use should be limited to adjuvant
  31. Desensitization  For food allergy, desensitization through sublingual, oral or epicutaneous immunotherapy is possible for a subset of people, but not all.While not a cure, this program enables food allergic children and adults to consume foods that they were allergic to previously, without any allergic reaction.  Desensitization approaches for food allergy are generally at the research stage. They include:  Oral immunotherapy, which involves building up tolerance by eating a small amount of (usually baked) food;  Sublingual immunotherapy, which involves placing a small drop of milk or egg white under the tongue;  Epicutaneous immunotherapy, which injects the allergic food under the skin;  Monoclonal anti-IgE antibodies, which non-specifically reduce the body's capacity to produce an allergic reaction; and  use of probiotics;  helminthic therapy; and  a drug to suppress Toll-like receptor 9 (TLR9).
  32. To recap, be sure to:  Learn all you can about avoiding allergens. Read food labels carefully and don’t hesitate to ask questions when eating away from home. Vigilance is your first line of defense against anaphylaxis.  Have your medication with you wherever you go.  Talk to your allergist about when and how to use emergency medications.  Make sure prescriptions are up-to-date.  Wear medical identification (e.g., bracelets, other jewelry) at all times.  Don’t delay using your epinephrine while waiting to see if your symptoms improve! Use your emergency medications as prescribed.  Get to an emergency room for evaluation and further treatment right away – even if your medication has stopped the reaction.  Epinephrine is not a “foolproof” treatment. Don’t take chances by eating a problem food.  Probiotic drinks and yoghurts promote gut immunity, meaning you
  33. THANK YOU!