1. Food Allergy Awareness Dana Magee ARAMARK Dietetic Intern May 3, 2013

2. Overview What is a food allergy? Top 8 food allergies Lactose intolerance Celiac Disease Food labeling How to stay safe

3. Application to the Nutrition Links Program Paperwork includes a question about food allergies Label reading to keep food demonstrations safe to those with allergies How to recognize a reaction in class and what to do Underdiagnosed in this population may encourage to see their doctor

4. Food Allergy Experiences in Nutrition Links?

5. Food Allergies Affects about 15 million Americans 1 in every 13 school age children CDC found 18% increase between 1997-2007 Other diseases affecting immune system have been increasing

6. Adverse Food Reaction Food Allergies: adverse immune reaction to food protein with a range of symptoms and potentially anaphylaxis Food Intolerances: adverse reaction to food that does not involve immune system but the digestion of the food

7. Top Eight Food Allergens These 8 make up 90% of all food allergies!

8. What causes a food allergy? Our immune system responsible for fighting off illnesses When exposed to something foreign (germ) our body recognizes it as dangerous and fights it off and creates antibodies to remember it Abnormal response to food- can be any food

9. Signs and symptoms of a food allergy Hives, eczema, red around eyes, itchy ears/ mouth, runny nose, cough Nausea, vomiting, diarrhea, stomach pain Anaphylaxis: breathing and circulation problems – Teen and young adults at highest risk – Asthma increases risk

10. Anaphylaxis Anaphylaxis: breathing and circulation problems – LIFE THREATENING – Swelling of lips, throat, tongue – Trouble swallowing – Turning blue – Drop in blood pressure – Chest pain/ weakness – Loss of consciousness

11. Anaphylaxis – Described by a child “This food is too spicy” “My tongue is burning” “It feels like something’s poking my tongue” “My mouth itches” “There’s a frog in my throat” “My tongue feels heavy”

12. Treatment of Anaphylaxis Epinephrine prescribed by physician in auto- inject pen Always go to the emergency room 25% of people have a second reaction called biphastic anaphylaxis Doctor may treat with steroids in ER

13. Diagnosis of Food Allergies Board certified allergist Don’t self diagnose Skin prick test Blood test Oral food challenge Elimination diet

14. Peanut Allergy One of the most common, tripled from 1997- 2008 20% can outgrow this allergy Having sibling with allergy increases risk Can cause anaphylaxis Treat by avoiding peanuts and peanut products

15. Peanut Allergy Even a small amount ingested can trigger life threatening response Touching peanuts can cause a reaction if then touch eyes/nose/mouth 25-40% also have tree nut allergy – Often manufactured on same equipment so best to avoid

16. Tree Nut Allergy Can cause anaphylaxis Walnuts, almonds, hazelnuts, cashews, pistachios, brazil nuts etc. 9% children will grow out of it Siblings at greater risk Coconut: fruit vs. nut- must be cleared by allergist Careful of shampoos, lotions, and soaps

17. Finned Fish Allergy Can cause anaphylaxis 40% people have first reaction as an adult Lifelong allergy 20,000 fish species: salmon, tuna, halibut most common Shellfish are separate allergy

18. Shellfish Allergy Can cause anaphylaxis 60% experience first reaction as adults Most common: shrimp, crab, lobster- crustaceans Mollusk family: clams, mussels, oysters, scallops – May be less severe- one or both families Can be airborne: avoid seafood restaurants, fish market, cooking fish (steam)

19. Soy Allergy Most common in babies and 0.4% of children Usually outgrown by age 3-10 Mild reaction but chance of anaphylaxis In many processed foods

20. Egg Allergy Second most common in children Symptoms of hives to anaphylaxis Most outgrow it It is the egg white, whole egg must be avoided Vaccines, MMR is safe, flu shot may not be

21. Cow’s Milk Allergy Most common food allergy in infants and children Hives to anaphylaxis 2.5% under three have this allergy, most outgrow it Careful of kosher labeling of “D” or “pareve” may contain milk In cooking substitute milk with water or fruit juice in equal parts

22. Milk protein allergy vs. lactose intolerance Milk protein allergy – Body starts an attack – Can lead to life threatening anaphylaxis Lactose intolerance: – “milk sugar” is not properly digested – Not life threatening

23. Wheat Allergy Usually in children and outgrown by age 3 Symptoms of hives to anaphylaxis Wheat free: amaranth, barley, corn, oat, quinoa, rice, rye, tapioca (may also be allergic to some of these)

24. Celiac Disease Genetic, exposure to gluten, environmental trigger, autoimmune response Gluten is the protein in wheat, rye, and barley Symptoms: bloating, gas, diarrhea, constipation, headaches, itchy skin, mouth sores, nausea, anemia, ADD, bone pain, depression, enamel effects, failure to thrive, fatigue, infertility Biopsy diagnosis, blood work

25. What is gluten free?

26. Celiac disease Doesn’t cause anaphylaxis Flattens the villi and elongates crypt cells Affects secretory, digestive, and absorptive ability Leads to micronutrient or macro nutrient deficiency

27. Celiac disease: Complications GF foods may not be fortified Malabsorption: osteoporosis – Calcium, vitamin D Diarrhea: replete electrolytes and fluids Multivitamin Develop lactose intolerance

28. Gluten Free Diet Even small amounts can cause this reaction Cross contamination is a huge concern! Substitutions for wheat flour: Rice flour, potato starch flour, soy flour, corn flour

29. Food labeling Food Allergen Labeling and Consumer Protection Act (FALCPA)-2006 Any packaged food with peanuts, milk, eggs, crustacean shellfish, tree nuts, wheat, and soy must be listed on label “ Contains…” If in small amounts (food coloring, flavor, spices etc.)- in parentheses

30. Food labeling Meat, poultry, eggs, alcohol not under this law Always check labels: manufacturers can change ingredients Any questions: call the manufacturer In process of “May contain…” labeling

31. Food Allergy Research and Education Tool

32. Food safety at home Everyone learn to read food labels Wash hands before, during, after handling food Clean surfaces and preparation equipment with soap and water Avoid cross contamination with separate cutting boards, utensils, bowls etc.

33. Food safety at home Designate different shelves Control areas of house where food can be eaten If cooking two meal: cook allergen free first If suffer from airborne allergens allow 30 minutes after prep

34. Eating out safely Ask allergist or friends with allergies for suggestions Look at the menu ahead of time Call and speak with manager ask about ingredients, cross contamination Go at less busy times Bring chef card Bring emergency medications

35. Eating out safely Sit away from the kitchen if have an airborne allergy How is it prepared? Grill or fryers cross contamination Alert the waiter, ask for manager or chef Careful of desserts not made on site If uncomfortable with ability to eat safely DO NOT eat Order steamed veggies or baked potato

36. Babysitter Training Set time for babysitter to come over while you are there Make sure to explain all allergies and what to avoid Take time to answer any questions Address take out food Go over emergency allergy plan

37. Gluten Free Voluntary Labeling

38. Gluten Free Flour (1 lb.)vs. All Purpose Flour (5 lb.)

40. Where is the labeling?

41. References Gupta R. Study: Food Allergies in Children Becoming More Common, Severe [Video]. PBS Newshour; 2011. Food Allergy Research & Education. Facts and Statistics. FARE. http://www.foodallergy.org/facts-and-stats. Updated 2013. Accessed May 3, 2013.http://www.foodallergy.org/facts-and-stats U.s. Department of Health and Human Services. Food Safety. HealthyPeople.gov. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=14. Updated April 10, 2013. Acessed May 3, 2013. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=14 The Ohio State University Extension. Cultural Diversity: Eating in America African American. The Ohio State University Extension. http://ohioline.osu.edu/hyg-fact/5000/pdf/5250.pdf. Published 2010. Accessed April 18, 2013.http://ohioline.osu.edu/hyg-fact/5000/pdf/5250.pdf Philadelphia Department of Public Health. Overview of Chronic Disease and Healthy Eating and Active Living Indicators for Philadelphia Adults and Children. Philadelphia Department of Public Health. http://www.phila.gov/health/pdfs/Philadelphia_obesity%20and%20chronic%20disease%20health%20indicator s_2010.pdf. Published May 5, 2011. Accessed May 3, 2013. http://www.phila.gov/health/pdfs/Philadelphia_obesity%20and%20chronic%20disease%20health%20indicator s_2010.pdf Penn State Extension. 2012 EFNEP Fact Sheet. Penn State Extension. http://extension.psu.edu/health/nutrition-links/about/annual-reports/2012/nutrition-links-annual-report-2012- efnep.pdf/view. Updated 2013. Accessed May 3, 2013. http://extension.psu.edu/health/nutrition-links/about/annual-reports/2012/nutrition-links-annual-report-2012- efnep.pdf/view City-data.com. Philadelphia County, Pennsylvania (PA) Religion Statistics Profile Philadelphia. City-Data.com. http://www.city-data.com/county/religion/Philadelphia-County-PA.html. Accessed April 18, 2013. http://www.city-data.com/county/religion/Philadelphia-County-PA.html