1. Food Allergies Food Intolerances and Disabilities August/September 2012 CACFP Training

2. What are the Rules? Medical or Religious Reason for needing food substitutions Disability Allergy or Religious Reason Parent Preference Milk Lets go through the Handout

3. Next …. Food Allergy Food Intolerances Disability Examples of some common Diseases Diabetes Celiac Disease PKU

4. Food Allergy Sensitivity to chemical compounds (proteins) naturally found in food Develop after exposure to a food protein that body thinks is harmful Its an abnormal response of the immune system to a particular food or food component

5. 8 Foods included in food allergy labeling required by FDA Milk Eggs Peanuts Tree Nuts Fish Shellfish Soy Wheat

6. Food allergies Involve 2 features of the human immune response 1) Production of immunoglobulin E ()IgE) A type of protein called an antibody that circuclates through the blood 2) Mast cell, a specific cell that occurs in all body tissues but is especially common in areas of body that are typical sites of allergic reactions (including nose & throat, lungs, skin & gastrointestinal tract

7. Forming IgE Inherited predisposition First has to be exposed to the food As food is digested, it triggers certain cells to produce IgE in large amounts IgE released and hooks to Mast Cells Next time person eats the food it interacts with specific IgE & triggers the mast cells to release chemicals such as histamine

8. The Allergic Reaction Vomitting Diarrhea Itching in Mouth BP may drop Hives - Eczema Throat tightness Breathing Difficulty Anaphylactic Shock An allergic reaction to food can take place within a few minutes to hours.

9. Symptoms of Food Allergy Rash or hives or eczema Abdominal pain, diarrhea, nausea, vomiting Tingling or itching in the mouth or skin Wheezing, nasal congestion or trouble breathing Dizziness, lightheadedness or fainting Swelling of the lips, face, tongue, and throat, or other parts of the body Anaphylaxis

10. No cure for food allergies Avoid the Offending Food is the only way to prevent a reaction

11. Exercise-induced food allergy Some people have an allergic reaction to a food triggered by exercise Eating certain foods may cause person to feel itchy and lightheaded soon after they start exercising Not eating a couple of hours before exercising & avoiding certain foods may help prevent this problem

12. Anaphylaxis Most severe allergic reaction Involves multiple systems at the same time Potentially fatal if medication not given promptly Can occur within minutes of exposure Peanut/tree nut allergies in combo with asthma is the highest risk If child has life-threatening allergies it is considered a disability in Child Nutrition

13. Symptoms of Anaphylaxis Skin reactions, including hives along with itching, flushed or pale skin (almost always present with anaphylaxis) A feeling of warmth Constriction and tightening of airways A swollen throat or the sensation of a lump in the throat that makes it difficult to breathe Weak and rapid pulse Dizziness, lightheadedness or loss of consciousness

14. Food Intolerances Lacks the chemicals called enzymes, necessary to properly digest certain proteins found in food Intolerances to some chemical ingredients added to food to provide color, taste, or protect against growth or bacteria Sulfites can be a source of intolerance (naturally or added to prevent growth of mold) Salicylates are group of plant chemicals found in many fruits, veg, juices

15. Symptoms of Food Intolerance Nausea Stomach Pain Gas, cramps, bloating Vomiting Heartburn Diarrhea Headaches Irritability or Nervousness

16. Tell the difference? ALLERGY Allergies can be triggered by even small amounts – occur every time food consumed Advised to avoid offending foods completely INTOLERANCE Intolerance is dose related Found through trial and error (food diary) Elimination diet and reintroduce foods one at a time

17. Disability Anyone who has a physical or mental impairment, which substantially limits one or more of he major life activities, has a record of such impairment, or is regarded as having such an impairment.

18. Disability Determination can only be made by a licensed physician What is disability How it restricts diet Major life activity affected Foods to be omitted Foods to be substituted Easiest way is to use our medical statement

19. Common Food Related Disabilities Diabetes Celiac Disease PKU

20. Diabetes The body cannot produce or use insulin Insulin = a hormone that helps the body to use glucose as energy Type 1 Type 2 (typically in adults)

21. Type 1 Diabetes Normally, the hormone insulin helps glucose enter the child's cells to provide energy to the muscles and tissues. When working properly, once a child eats, the pancreas secretes more insulin into the bloodstream and it circulates & opens doors so sugar can enter the bodys cells. Type I -Pancreas produces little or no insulin

22. Diabetes Blood sugar monitoring – many times a day Glucose monitoring (CGM) – newest way to monitor blood sugar levels (used as an additional tool to blood sugar monitoring) Insulin treatment

23. Diabetes Lifestyle Considerations Healthy Eating - high in nutrition and low in fats and calories Fruits & vegetables, Whole Grains, Low fat/low sugar Physical Activity – can affect blood sugar levels up to 12 hrs. after exercise

24. Type 2 Diabetes Most common in adults but on the rise in children – fueled by obesity Pancreas stops producing enough insulin Treated with diet/exercise and oral meds Prevention: Eat healthy foods Get more physical activity Manage weight

25. Celiac Disease Genetically-based autoimmune disease characterized by sensitivity to the protein gluten

26. Celiac Disease Dietary treatment Only treatment is gluten-free diet Cannot eat the protein from the following grains: Wheat, barley, rye, and hybrids of these grains These grains may be eaten: Corn, rice, sorghum, teff, wild rice, millet, amaranth, quinoa, and buckwheat

27. Celiac Disease Where is Gluten found? Flour, bread, bread products (e.g. pizza crust), pasta, and breakfast cereals May be an ingredient in many other foods including soups, hotdogs, gravies, and French fries Read food labels Wheat, barley, rye, malt, oats (due to gluten contamination), brewers yeast, modified food starch, Dextrin, Semolina, farina, durum flour, enriched flour, and graham flour

28. Phenylketonuria (PKU) Cannot process the amino acid phenylalanine Dietary treatment: Low protein diet (to prevent increase in phenylalanine) Special formula to provide protein

29. For More Information see NFSMI www.nfsmi.org Special needs training