1. Food Allergies Food Intolerances and Disabilities

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

3. What is the difference?
Food Allergy
Food Intolerances
Disability

4. 8 Foods included in food allergy labeling required by FDA
Milk
Eggs
Peanuts
Tree Nuts
Fish
Shellfish
Soy
Wheat
Mayocliic.com
The FDA requires food labels to list common allergens in language that's easy to understand. Allergens are listed either in the ingredients list, after the list or right next to it.
Food labeling laws require food allergens to be identified even in very small amounts — but only when they're contained as an ingredient. Manufacturers aren't required to include warnings about food allergens accidentally introduced during manufacturing or packaging (cross contamination).
Many manufacturers voluntarily include warnings, but these advisory labels aren't always clear. And, manufacturers have different ways of saying a food allergen may be present. For example, labels may say "manufactured in a factory that also processes wheat" or "may contain soy." The FDA is working to make the format of these advisory labels more consistent so that it's easier to identify which products contain allergens. When in doubt about whether a product contains something you're allergic to, it's best to avoid it.

5. Food Allergy
Sensitivity to chemical compounds (proteins) naturally found in food
Develop after exposure to a food protein that body thinks is harmful
It’s an abnormal response of the immune system to a particular food or food component
Webmd:
Food allergies arise from sensitivity to chemical compounds (proteins) in food. They develop after you are exposed to a food protein that your body thinks is harmful. The first time you eat the food containing the protein, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, it triggers the release of IgE antibodies and other chemicals, including histamine, in an effort to expel the protein "invader" from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system.
Mayoclinic.com
Affects estimated 6-8% children under 5 and 3-4% adults

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 circulates through the blood 2) Mast cell releases histamine, 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
Webmd.com

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
Webmd.com

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

10. 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
Mayoclinic.com
From webmd.com
As a result of this response, food allergy symptoms occur. The allergy symptoms you have depend on where in the body the histamine is released. If it is released in the ears, nose, and throat, you may have an itchy nose and mouth, or trouble breathing or swallowing. If histamine is released in the skin, you may develop hives or a rash. If histamine is released in the gastrointestinal tract, you likely will develop stomach pains, cramps, vomiting or diarrhea. Many people experience a combination of symptoms as the food is eaten and digested.
Often run in families

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

12. 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
Mayoclinic.com

13. 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

14. 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
Mayoclinic.com

15. Brochure What is a food Allergy? What are some common Food Allergies?
Identify the Symptoms related to Food Allergies
What do I do in case of an Allergic Reaction?
At least 4 Pictures

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. 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

18. Symptoms of Food Intolerance
Nausea
Stomach Pain
Gas, cramps, bloating
Vomiting
Heartburn
Diarrhea
Headaches
Irritability or Nervousness
From webmd.com

19. 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
Determination can only be made by a licensed physician

20. Common Food Related Disabilities
Diabetes
Celiac Disease
PKU

21. 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)

22. 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 body’s cells.
Type I -Pancreas produces little or no insulin
Body’s own immune system destroys the insulin-producing cells in pancreas
Insulin is key to sugar entering the cells

23. 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

24. 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
High sugar or high fat – difficult to incorporate
High fat foods – fat slows digestion so may cause spike in blood sugar levels several hours later
When starting new exercise program monitor blood sugar more often
Medical statement should give you guidance on managing blood glucose levels – have a target blood glucose range
Limit simple sugars and fats. Provide adequate complex carbohydrates and proteins

25. 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

26. Celiac Disease
Genetically-based autoimmune disease characterized by sensitivity to the protein gluten
From NFSMI presentation

27. 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

28. Celiac Disease Where is Gluten found? Read food labels
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), brewer’s yeast, modified food starch, Dextrin, Semolina, farina, durum flour, enriched flour, and graham flour
From NFSMI presentation

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