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Diet and Health Guidelines for Food Allergies and Food Intolerances Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist Who Has Food Allergies 3-5% of young children are diagnosed with a food allergy Most childhood food allergies appear early in life and are usually outgrown 1-2% of the adult population have a food allergy Who Has Food Allergies Although anyone can develop a food allergy, the ability to become allergic tends to be inherited Many people who have food allergies also have asthma, or show sensitivities to inhaled allergens such as dust, pollen and animal dander What Is A Food Allergy A food allergy is an adverse reaction to a food or food component that involves the immune system A food allergen is the part of a food to which a person is allergic Often an incompletely digested protein What Happens With A Food Allergy When someone eats a food they are allergic to, the food allergen stimulates the immune system to release antibodies The antibodies cause body cells to release other substances, which cause allergic reactions Food Allergy Symptoms Allergic reactions can be immediate or delayed Allergic reactions to foods usually occur within minutes to 24 hours after eating an offending food In very sensitive people, even touching or inhaling the offending food may produce an allergic reaction Food Allergy Symptoms Food allergy reactions vary from person to person, as well as within the same person The same food can produce totally different symptoms in different people, as well as varying symptoms within the same person Food Allergy Symptoms Food allergy symptoms usually fall into three areas: Skin Reactions Nose, Throat and Lung Reactions Stomach and Intestinal Reactions Skin Reactions Types of reactions Swelling of lips, mouth, tongue, face or throat Hives Rashes Itching Skin redness With oral allergy syndrome Hives, swelling and itching confined to the mouth and throat and usually result after consumption of raw fruits and vegetables Nose, Throat and Lung Reactions Types of reactions Sneezing Nasal congestion Runny nose Chronic cough Shortness of breath or other breathing difficulties such as asthma Stomach and Intestinal Reactions Types of reactions Nausea Abdominal pain and bloating Vomiting Diarrhea Cramping Gas Severe Allergy Reactions Most food allergic reactions are mild, but a small number of food-allergic individuals have severe reactions that can be life-threatening Anaphylaxis is rare, but can be a possibly fatal food allergy reaction Anaphylaxis Different parts of the body may experience food allergy reactions at the same time Reactions can progress rapidly and may include: Itching Hives Sweating Throat swelling Breathing difficulties Lowered blood pressure Unconsciousness Even death Have A Plan People who have severe allergic reactions need to recognize early symptoms and have a plan for handling emergency situations May carry epinephrine for self-injection and warning medical alter bracelets or necklaces in case they become unconscious Importance of Diagnosis Properly diagnosing food allergies is important Proper diagnosis can help avoid unnecessary dietary restrictions Parents may limit their children’s food intakes unnecessarily unless properly diagnosed Proper diagnosis can also help avoid accidental exposure to allergens Proper Diagnosis Diagnosis requires a thorough medical history, physical examination, and laboratory tests Having symptoms is not a diagnosis Symptoms exactly like those of an allergy many not be caused by one Proper Diagnosis Methods for diagnosis Skin-prick test Antibody blood testing Oral Food Challenges Elimination Diets RAST or ELISA Radioallergosorbent test (RAST) or enzyme- linked immunosorbent assay (ELISA) are reliable skin-prick testing and antibody blood testing for diagnosing allergies Proper Diagnosis Food changes and elimination tests should be conducted only under medical supervision Unreliable Methods Two unreliable methods for diagnosing food allergies are cytotoxic testing and symptom provocation testing, where a dose of the food extract is placed under the tongue or injected Most Common Food Allergies Food allergies can occur to almost any food, but most allergic reactions are caused by a limited number of foods milk eggs wheat fish shellfish soy peanuts tree nuts like walnuts Living With A Food Allergy The only proven treatment for a food allergy is to avoid the offending food An elimination diet must be carefully developed and be personalized to take into account the ability of an individual to tolerate an allergic food Living With A Food Allergy Using an elimination diet for 1-2 years may promote outgrowing a food allergy Some food allergies, particularly to peanuts, nuts, fish and shellfish can last a lifetime Living With A Food Allergy No drugs are available to treat food allergies Allergy shots, which are useful in desensitizing some people to pollen and other environmental allergens, are not recommended to treat food allergies and may be dangerous Living With A Food Allergy People with food allergies need to learn about food composition and how to read labels Many foods may contain the allergen Many terms used to describe food components Milk Allergy Milk and milk products are a common ingredient in many foods so food labels need to be checked carefully Milk Allergy Foods containing milk or milk products Milk Acidophilus, buttermilk, chocolate milk, evaporated milk, condensed milk, sweetened condensed milk, malted milk, *Goat’s milk protein similar to cow’s milk protein, may cause similar symptoms, not a recommended substitute Cheese Ice cream Sherbet Yogurt Custard Pudding Eggnog Milk Allergy Foods containing milk or milk products Cream, half & half cream, light cream, whipping cream Sour cream, sour cream solids, sour cream dressing Butter, butter oil, butter fat, artificial butter flavor Nougat Mellorine Curds Semi-sweet chocolate, milk chocolate Caramel, creamed, carob candies Milk Allergy Terms for milk products Casein Rennet casein Amonium caseinate Calcium caseinate Magnesium caseinate Potassium caseinate Sodium caseinate Casein hydrolysate Milk protein hydrolysates Protein hydrolysate Milk Allergy Terms for milk products Lactose Lactablumin Lactalbumin phosphate Lactoglobulin Lactulose Milk protein Whey Whey protein concentrate Whey protein hydrolysate Sweet whey Delactosed whey Milk Allergy Ingredients potentially containing milk or milk products Caramel flavoring Bavarian cream flavoring Coconut cream flavoring Brown sugar flavoring Butter flavoring Natural flavoring Simplesse® Egg Allergy Eggs and egg proteins are common ingredient in many foods so food labels need to be checked carefully Because flu vaccines are prepared using egg embryos, people with egg allergies need to check with their physicians before being vaccinated Egg Allergy Eggs or foods containing egg products Eggs, egg white, egg yolk Dried eggs, frozen eggs, powdered eggs, egg solids Egg substitutes Imitation egg product Béarnaise sauce Hollandaise sauce Eggnog Mayonnaise Meringue Simplesse® Egg Allergy Terms for egg or egg products Albumin Apovitellin Avidin Egg lecithin Flavoprotein Globulin Livetin Lysozyme Ovalbumin, conalbumin Ovomucin Wheat Allergy Wheat is a common ingredient in many foods so food labels need to be checked carefully Wheat Allergy Wheat or wheat products Atta wheat flour Bal ahar Bread flour Bulgur Cake flour Cereal extract Courscous Cracked wheat Durum Durum flour Wheat Allergy Wheat or wheat products Enriched flour Farina High protein flour Kamut flour Laubina Leche alim Malted cereals Minchin Multi grain breads Multi grain flours Wheat Allergy Wheat or wheat products Puffed wheat Red wheat flakes Rolled wheat Semolina Shredded wheat Soft wheat flour Spelt SuperArmine Triticale Vital gluten Wheat Allergy Wheat or wheat products Vitalia macaroni Wheat protein powder Wheat bran Wheat germ Wheat gluten Wheat meal Wheat pasta Wheat protein Wheat starch Wheat tempeh Wheat Allergy Wheat or wheat products White flour Whole wheat berries Whole wheat flour Winter wheat flour Wheat Allergy Ingredients potentially made from wheat Hydrolyzed vegetable protein Vegetable starch Starch Gelatinized starch Modified starch Modified food starch Vegetable gum Peanut Allergy Some people with peanut allergies have severe reactions, including anaphylaxis, to the smallest quantities of peanuts Although peanut allergy is not ordinarily associated with other nut allergies, people may be advised to avoid all nuts due to potential cross-contamination Peanut Allergy Peanuts, peanut products, foods containing peanuts Beer nuts Eggrolls Ground nuts High protein food Hydrolyzed plant protein Hydrolyzed vegetable protein Marzipan Mixed nuts Nougat Peanut Allergy Peanuts or peanut products Peanuts Peanut flour Peanut soup Peanut butter Peanut oil Peanut flakes Peanut Allergy Products that may contain peanuts Pie crusts Cheese cake crusts Chocolate candy Ice cream Baked goods Sauces Chili Candy Other Types Of Food Reactions Some people have adverse reactions to foods that do not involve the immune system These are referred to as "food intolerances“ they are not food allergies Causes of Food Intolerances Food intolerances may be caused by: Enzyme deficiencies Reactions to chemicals in foods Sulfur Digestive diseases Metabolic Intolerances A metabolic intolerance is when the body cannot adequately digest a portion or component of a food For example lactose intolerance and gluten intolerance Lactose Intolerance People with lactose intolerance cannot digest (breakdown) lactose in milk Lactose is a disaccharide (sugar) in milk Lactose is digested by the enzyme lactase into two monosaccharides, glucose and galactose, which can be absorbed by the small intestine Lactose Intolerance If there is not enough lactase, the lactose is goes undigested the intact lactose moves into the large intestine and is fermented by normal bacteria found in the large intestine The amount of lactase produced tends to decrease in adulthood Incidence of lactose intolerance varies for different populations. Symptoms Of Lactose Intolerance Symptoms include cramps, bloating, intestinal gas, diarrhea and nausea Severity of symptoms varies with the amount of lactose consumed and degree of intolerance Symptoms appear from 15 minutes to several hours after eating foods or beverages containing lactose Is Lactose Intolerance A Milk Allergy? A milk allergy is an allergic reaction to the protein components in milk, not the lactose in milk People with milk allergy usually must avoid all milk products. People with lactose intolerance can use certain dairy products that are low in lactose How Much Lactose Amount of lactose allowed depends on the degree of lactose tolerance Many can tolerate 6 grams lactose (1/2 C milk) Many can tolerate fermented products such as yogurt and acidophilus milk Hard cheeses and cottage cheese may be tolerated because most of the lactose is removed with whey How Much Lactose Many foods contain small amounts of lactose, for example breads, dry cereals, cold cuts, cream soups, salad dressings, candy, cookies, drink mixes, and sugar substitutes Most people can handle the small amount of lactose in these foods How Much Lactose Very sensitive people need to check food labels carefully for: Milk Whey Lactose Nonfat milk solids Dry milk solids Curds Cheese Margarine Sweet or sour cream Lactobacilus Many people can use commercially prepared milk products that have been treated with an enzyme (lactobacilus) that breaks down lactose Alternatively, people can take enzyme tables with meals or add enzyme drops to their milk Example: Lact-aid, Dairy-ease, Lactinex Gluten Intolerance Gluten is a protein found in wheat, rye, and barley or derivatives of these grains such as malt Some individuals cannot tolerate the gliadin fraction in gluten Gluten Intolerance Gluten intolerance is also referred to as celiac disease, celiac-sprue, nontropical sprue or gluten sensitive enteropathy Individuals do not outgrow gluten intolerance Symptoms Of Gluten Intolerance As a result of gliadin intolerance the intestinal lining is flattened which results in reduced food absorption, diarrhea, steatorrhea (fat in the stool), bloating, loss of appetite, muscle wasting, weight loss and can lead to progressive malnutrition Symptoms Of Gluten Intolerance Lactose intolerance may temporarily occur secondarily to gluten intolerance However, lactose containing foods can be returned to the diet within a short time Gluten Intolerance Gluten containing grains Wheat Rye Barley Oats Although oats is gluten-free, the use of oats is controversial due to contamination with wheat during processing A limited intake of oats (40 to 60 g/day) is currently considered acceptable Gluten Intolerance Non-gluten containing grains Tapioca Corn flour Corn starch Rice flours Potato starch Potato flour Soy flour Gluten-Free Flour Substitute Gluten-free flour mix Rice flour 6 cups Potato starch 2 cups Tapioca flour 1 cup Food Additive Intolerances Although most individuals consume a wide variety of food additives each day, only a small number have been associated with intolerances to food additives Yellow No. 5 or Tartrazine Sensitivity Yellow No. 5 is a food color additive Although rare, yellow dye No. 5 may cause hives in some individuals Whenever Yellow No. 5 is added to a food, it should be listed on the product food label Carmine Sensitivity Carmine is an extract of the cochineal insect used as a bright red dye in a number of products Occasional reactions to carmine used as a food coloring have been reported If carmine is added to a food it should be listed on the product food label Monosodium glutamate (MSG) MSG is a flavor enhancer MSG is the sodium salt of glutamic acid, an amino acid found naturally in all protein A few people report mild and short-lived reactions after eating MSG If MSG is added to a food it is listed on the label as monosodium glutamate Sulfites Sulfites are used to preserve color of foods and inhibit microorganism growth Some people develop shortness of breath or fatal shock shortly after exposure to sulfites Sulfites can produce severe asthma attacks in sulfite-sensitive asthmatics Sulfites FDA banned the use of sulfites on fresh fruits and vegetables (except potatoes) intended to be sold to consumers raw Sulfites added to all packaged and processed foods must be listed on the product label Aspartame Some people have complained of adverse reactions to aspartame However, in clinical studies aspartame has not shown allergic reactions FDA concluded there is no evidence of a cause and effect between aspartame and sensitivities reported