1. Food Allergies Paediatric Dietetic Department

2. Aims Of The Session Increase awareness of Common types of food allergy
Symptoms of food allergy
Practical considerations for management of food allergy in schools

3. Food Allergy 6-8% of children have a proven food allergy
Food allergies occur when the body’s immune system perceives a food protein to be harmful & acts against it
As a result of this action, chemicals are released (e.g. histamine) and it is these chemicals which cause symptoms
There is no cure for food allergy, complete and strict avoidance of the food is the only way to prevent a reaction
NICE guidelines, 2011

4. Types of Reaction IgE Non-IgE
Quick ‘Acute’ onset
Anaphylaxis
Well-defined mechanism
Fairly easy to diagnose
Validated tests
-Specific serum IgE assays
-Skin Prick Tests
-+/- supervised Challenges
Mild to moderate ‘Delayed’ onset
Mechanisms unclear
Harder to diagnose
No validated tests
- Elimination diet with planned challenge
NICE Guidelines 2011
Non IgE -- More commonly known as food intolerance!!

5. Possible Food Allergy Symptoms
IgE mediated Symptoms
Non IgE mediated symptoms
The skin
Acute Pruritus
Pruritis
Erythema
Acute angioedema (most commonly in the lips and face, and around the eyes)
Significant atopic eczema
Urticaria

6. Possible Food Allergy Symptoms
IgE mediated symptoms
Non-IgE mediated symptoms
Gastrointestinal system
Colicky abdominal pain
Abdominal discomfort
Vomiting
Gastro-oesophageal reflux disease
Diarrhoea
Loose or frequent stools, constipation, blood or mucus in stools
Food refusal or aversion
Perianal redness
Faltering growth

7. Possible Food Allergy Symptoms
IgE mediated Symptoms
Respiratory System (usually in combination with one or more of the previous symptoms and signs)
Upper respiratory tract symptoms (nasal itching, sneezing, rhinorrhoea or congestion [with or without conjunctivitis])
Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)
Note, this list is not exhaustive!!

8. Life Threatening Anaphylaxis Symptoms
All of the symptoms of IgE mediated reaction
Difficulty breathing
Swelling around tongue / throat
Redness of skin
Collapse
→Adrenaline auto injector
Note, not all children with a food allergy will experience anaphylactic symptoms

9. Which foods are involved?
For children the most common food allergies are:
Cows milk Protein
Eggs
Peanuts
Tree nuts
Fish
Shellfish

10. Cow’s Milk Allergy (CMA)
Occurs when the body’s immune system reacts to proteins found in milk
Up to 7% of children have a CMA and usually presents in infancy
Most children will outgrow it (average age 5 years for IgE mediated and majority by age 3 years for uncomplicated non-IgE mediated allergy)
BMJ 2013;347:f5424

11. Cows Milk Containing Foods:
Butter
Yoghurt
Cheese
Margarine
Ice cream
Cream
Milk powder
Breads containing milk such as pancake, wheaten, soda
Cakes, buns, biscuits, chocolate
Processed foods

13. Egg Allergy Egg allergy can be:
- mild i.e. can tolerate well cooked egg
- severe i.e. can’t tolerate any form of egg
~50% of children with egg allergy can eat well cooked egg e.g. cakes and biscuits
Children who are allergic to loosely cooked or raw egg, the reactions are often severe
~50% of children grow out of an egg allergy in about the first 5-7 years of life, but in the rest it is likely to persist

14. WELL COOKED EGG
LOOSELY COOKED EGG
RAW EGG
Cakes, biscuits
Meringues
Fresh mousse
Dried egg pasta
Lemon curd
Fresh Mayonnaise
Prepared meat dishes and sausages containing egg
Scrambled, boiled, poached or fried egg
Some ice-creams, (especially fresh and deluxe types) and sorbets
Egg glaze on pastry
Quiche
Royal Icing
Gravy granules (if they contain egg)
Omelette
Horseradish, tartar sauce
Pancakes and scotch pancakes (shop bought)
Egg custard
Some cheeses
Inside a Cadbury's cream egg
Egg in batter
Raw egg in cake mix
Breadcrumbs
Homemade pancakes

15. Nut Allergy
Unlike milk or egg allergies, children are unlikely to grow out of a nut allergy (about 1 in 5 will grow out of it)
Most first allergic reactions take place when child is between 14 months and 2 years old
The nut allergy may become less severe with age, but in 20%, it can become worse with time

16. Peanuts PEANUTS Arachis hypogaea Groundnuts Beer nuts Goober nut/pea
Cacahuete
Mandelonas
Chinese nuts
Monkey nuts
Earthnuts

17. Tree Nuts TREE NUTS Almond Macadamia Brazil Pecan Cashew Pistachio
Hazelnut
Walnut

18. Food Labelling
Children with a nut allergy are advised to avoid all nuts including foods which:
-‘may contain traces of nuts’ or
-‘made in a factory which handles nuts’
unless individual medical/dietetic advice has been given to family
It is important for the school to work together with family to provide suitable meals/snacks

19. Food Labelling
Current allergen labelling rules changed on 13 December 2014.
Under the new rules, allergens will be emphasised on the label.
…E.g.italics and underlined or highlighted words.
Some companies may also emphasise the whole word for example: use the words ‘from milk’ after listing the ingredient cream.
Please note, that the new rules will mean that a ‘contains x’ allergen statement can no longer be provided for food alongside an ingredients list.
Also, bear in mind that some products (such as tinned or dried food) have a long shelf life. It’s possible that you could see both types of labelling being used on these types of
products for a couple of years after December 2014.
It is important to always check the ingredients list for information about allergens.

20. Other Considerations Trips - careful forward planning
Cookery - check ingredients and provide alternatives if necessary
Treat days - supply any special snacks or "birthday treats" in a labelled tin
No sharing snacks – remind children each to eat their own snack

21. Other Considerations
School meals & Packed lunch – ‘free-from’ status (e.g. milk, eggs and nuts)
Activities e.g. arts and crafts - glues, paints, and old food cartons that may include food allergens
Cross contamination – take extra care with hand washing especially after lunch/snacks
Pets – bird seed, other pet foods
Aware schools are not obliged to have a ‘free-from’ policy but we would strongly encourage this!!

22. Food Allergy Resources
Allergy UK
The Anaphylaxis Campaign
The British Dietetic Association
National Institute of Clinical Excellence, 2011

23. Thank you for listening!
Any questions?