1. All About … Food Allergies

2. 02 Affect 6 to 8% of children 4 years of age and under Affect 5.9 million kids in the U.S. (1 in 13 kids or about 2 per classroom) Affect almost 4% of adults Account for 35 – 50% of all cases of anaphylaxis in emergency care settings Cause about 30,000 episodes of anaphylactic shock with 100 to 200 deaths per year Food allergies http://www.niaid.nih.gov/topics/foodAllergy/research/Pages/ReportFoodAllergy.aspx http://www.foodallergy.org/about-food-allergies http://www.cdc.gov/HealthyYouth/foodallergies/ pdf/13_243135_A_Food_Allergy_Web_508.pdf

3. 02 A food allergy is an abnormal reponse triggered by the body’s immune system to an otherwise harmless food. These reactions can cause serious illness and, in some cases, death. What is a food allergy?

4. True or False An allergic reaction will occur the first time a person comes in contact with the food they are allergic to and every time thereafter.

5. Answer: False: According to the National Institutes of Health, the first time a person with food allergy is exposed to the food, no symptoms occur; but the first exposure primes the body to respond the next time. When the person eats the food again, an allergic response can occur.

6. What is a first exposure to food? Can be when you eat it Can occur without your knowledge –Example: peanut allergy – A person who experiences anaphylaxis on the first known exposure to peanuts may have previously Touched peanuts Using a peanut-containing skin care product Breathed in peanut dust in the home or when close to other people eating peanuts

7. Components of a food, called “allergens,” trigger the immune system. The body produces antibodies that attach to cells throughout the body. (IgE antibodies) With the next exposure, antibodies recognize the allergen and signal the body to release histamine and other chemicals that cause the physical signs of an allergic reaction. What happens in a food allergy?

8. 02 Allergic reactions can include: Hives Flushed skin or rash Tingling or itchy sensation in the mouth Face, tongue, or lip swelling Vomiting and/or diarrhea Abdominal cramps Coughing or wheezing Dizziness and/or lightheadedness Swelling of the throat and vocal cords Difficulty breathing Loss of consciousness Anaphylaxis (“anaphylactic shock”) What are the symptoms of a food allergy?

9. How do you know if a person is having an anaphylactic reaction? Anaphylaxis is highly likely if at least one of the following three conditions occurs: 1. Within minutes or several hours, a person has skin symptoms (redness, itching, hives) or swollen lips and either Difficulty breathing, or A drop in blood pressure 2. A person was exposed to an allergen likely to cause an allergic reaction, and, within minutes or several hours, two or more of the following symptoms occur: Skin symptoms or swollen lips Difficulty breathing A drop in blood pressure GI symptoms such as vomiting, diarrhea, or cramping 3. A person exposed to an allergen previously known to cause an allergic reaction in that person experiences a drop in blood pressure http://www.niaid.nih.gov/topics/foodAllergy/ understanding/Pages/anaphylaxis.aspx

10. 02 An intolerance is a reaction to food that does not involve the immune system or production of IgE antibodies. Examples: –Lactose intolerance – body lacks the enzyme, lactase, to break down lactose (milk sugar). Symptoms include gas, bloating, abdominal pain, diarrhea. –Gluten intolerance – associated with Celiac Disease, an inherited autoimmune disorder in which foods that contain gluten cause damage to the intestines and can prevent the proper absorption of nutrients- does not involve IgE antibodies. –Reactions to additives (msg, sulfites). Difference between allergy and intolerance

11. 02 A physician can use diet histories diet elimination skin tests blood tests How do you know if you have a food allergy?

12. 02 90% of total food allergies are caused by these 8 foods: Peanuts Tree nuts (such as almonds, pecans, walnuts, etc.) Milk Eggs Soy Wheat Fish (such as bass, cod, flounder) Crustacean shellfish (such as crab, lobster, shrimp, etc.) What foods cause food allergies? – The “Big 8”

13. 02 Some people are so allergic, they can experience symptoms without ingesting the food. Airborne allergens in steam during cooking Cross-contamination and the spread of allergens Kissing someone who has eaten the allergen Do people have to eat a food to have an allergic reaction?

14. 02 The best treatment for food allergies and celiac disease is: strict avoidance of the foods that cause the problem. What is the treatment for food allergy?

15. 02 Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) effective since 2006 Labels must clearly identify the source of all ingredients that are — or are derived from — the eight most common food allergens. Laws about food allergies

16. 02 Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) effective since 2006 Labels must clearly identify the source of all ingredients that are — or are derived from — the eight most common food allergens. Laws about food allergies

17. Label Examples:

21. “May contain” labeling – not mandated, but companies may use it to warn consumers and reduce liability http://www.fda.gov/forconsumers/consumerupdates/ucm254504.htm

22. “May contain” labeling – not mandated, but companies may use it to warn consumers and reduce liability http://www.fda.gov/forconsumers/consumerupdates/ucm254504.htm

23. More Label Reading

27. In addition to avoidance, additional treatments that may be prescribed… Antihistamines/Bronchodilators Epinephrine

28. www.epipen.com/en/about-epipen Directions say patient should always carry 2 doses. Available in single and 2-pak cartons.

29. Prevention Starts In the Kitchen! Food Service should: Keep a list of ingredients in every food served. Read food labels. Know what to avoid and how to substitute. Designate an allergy-free zone where allergy-free meals can be made. Avoid cross-contamination and follow safe food handling practices.

30. Food Service Assistants should: Understand the school’s allergy plan. Identify the students with documented food allergies. Develop standardized cleaning procedures for the cafeteria. Learn to recognize signs of anaphylaxis, and know how to activate the school’s emergency plan if anaphylaxis should occur in a student with a life threatening food allergy. Preventing exposure to allergens school cafeterias and throughout the school

31. Handwashing or hand sanitizers? Hand sanitizers are not as effective at removing allergens Washing with soap and water is more effective

32. Wash for as long as it takes to sing “Happy Birthday” twice!

33. Hygiene and cleanliness It is also important for foodservice, teachers in schools and caregivers to: Wash their hands thoroughly and often Clean and sanitize utensils, equipment, surroundings, toys, etc.

34. Best Methods of “Cleaning” To Remove Allergens? According to the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, U.S. Dept. of Health and Human Services: Simple measures of cleanliness can remove most allergens from the environment of a person with food allergy. Simply washing your hands with soap and water will remove peanut allergens, and most household cleaners will remove allergens from surfaces.

35. Methods of “Cleaning” Research has found that: Conventional cleaning methods are effective in removing the protein of a food allergen such as peanut. Bar and liquid soaps are effective for removing the protein from hands, while alcohol-based sanitizer is not. Soaps and commercial cleaning agents effectively removed peanut protein from table tops, while dishwashing liquid alone did not. (J. Allergy Clin. Immunol. 2004;113:973-6.)

36. Resources Available –Food Allergy – An Overview, booklet from NIH – National Institute of Allergy and Infectious Diseases (~40 pages) www.niaid.nih.gov/topics/foodallergy/documents/food allergy.pdf –AAAAI (American Academy of Allergy, Asthma and Immunology) www.aaaai.org/conditions-and- treatments/allergies/food-allergies.aspx –FARE (Food Allergy Research and Education) www.foodallergy.org/

37. www.foodallergy.org/most-popular-resources –About Food Allergies –Managing at Home –Dining Out & Travel –Awareness & Educational Materials

38. Food Allergy is a Serious Health Threat It can be deadly Avoidance is the key

39. Judy A. Harrison, Ph. D., Professor and Extension Foods Specialist Dept. of Foods and Nutrition College of Family and Consumer Sciences University of Georgia. 2015 The University of Georgia and Ft. Valley State University, the U.S. Department of Agriculture and counties of the state cooperating. Cooperative Extension, the University of Georgia Colleges of Agricultural and Environmental Sciences and Family and Consumer Sciences, offers educational programs, assistance and materials to all people without regard to race, color, national origin, age, gender or disability. An Equal Opportunity Employer/Affirmative Action Organization Committed to a Diverse Work Force All About … Food Allergies