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Diet and Health Guidelines for Food Allergies and Food Intolerances. Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist. Who Has Food Allergies. 3-5% of young children are diagnosed with a food allergy

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Diet and Health Guidelines for Food Allergies and Food Intolerances

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diet and health guidelines for food allergies and food intolerances

Diet and Health Guidelines for Food Allergies and Food Intolerances

Presented by

Janice Hermann, PhD, RD/LD

OCES Adult and Older Adult Nutrition Specialist

who has food allergies
Who Has Food Allergies
  • 3-5% of young children are diagnosed with a food allergy
    • Most childhood food allergies appear early in life and are usually outgrown
  • 1-2% of the adult population have a food allergy
who has food allergies3
Who Has Food Allergies
  • Although anyone can develop a food allergy, the ability to become allergic tends to be inherited
  • Many people who have food allergies also have asthma, or show sensitivities to inhaled allergens such as dust, pollen and animal dander
what is a food allergy
What Is A Food Allergy
  • A food allergy is an adverse reaction to a food or food component that involves the immune system
  • A food allergen is the part of a food to which a person is allergic
    • Often an incompletely digested protein
what happens with a food allergy
What Happens With A Food Allergy
  • When someone eats a food they are allergic to, the food allergen stimulates the immune system to release antibodies
  • The antibodies cause body cells to release other substances, which cause allergic reactions
food allergy symptoms
Food Allergy Symptoms
  • Allergic reactions can be immediate or delayed
  • Allergic reactions to foods usually occur within minutes to 24 hours after eating an offending food
  • In very sensitive people, even touching or inhaling the offending food may produce an allergic reaction
food allergy symptoms7
Food Allergy Symptoms
  • Food allergy reactions vary from person to person, as well as within the same person
  • The same food can produce totally different symptoms in different people, as well as varying symptoms within the same person
food allergy symptoms8
Food Allergy Symptoms
  • Food allergy symptoms usually fall into three areas:
    • Skin Reactions
    • Nose, Throat and Lung Reactions
    • Stomach and Intestinal Reactions
skin reactions
Skin Reactions
  • Types of reactions
    • Swelling of lips, mouth, tongue, face or throat
    • Hives
    • Rashes
    • Itching
    • Skin redness
  • With oral allergy syndrome
    • Hives, swelling and itching confined to the mouth and throat and usually result after consumption of raw fruits and vegetables
nose throat and lung reactions
Nose, Throat and Lung Reactions
  • Types of reactions
    • Sneezing
    • Nasal congestion
    • Runny nose
    • Chronic cough
    • Shortness of breath or other breathing difficulties such as asthma
stomach and intestinal reactions
Stomach and Intestinal Reactions
  • Types of reactions
    • Nausea
    • Abdominal pain and bloating
    • Vomiting
    • Diarrhea
    • Cramping
    • Gas
severe allergy reactions
Severe Allergy Reactions
  • Most food allergic reactions are mild, but a small number of food-allergic individuals have severe reactions that can be life-threatening
  • Anaphylaxis is rare, but can be a possibly fatal food allergy reaction
  • Different parts of the body may experience food allergy reactions at the same time
  • Reactions can progress rapidly and may include:

Itching Breathing difficulties

Hives Lowered blood pressure

Sweating Unconsciousness

Throat swelling Even death

have a plan
Have A Plan
  • People who have severe allergic reactions need to recognize early symptoms and have a plan for handling emergency situations
  • May carry epinephrine for self-injection and warning medical alter bracelets or necklaces in case they become unconscious
importance of diagnosis
Importance of Diagnosis
  • Properly diagnosing food allergies is important
    • Proper diagnosis can help avoid unnecessary dietary restrictions
      • Parents may limit their children’s food intakes unnecessarily unless properly diagnosed
    • Proper diagnosis can also help avoid accidental exposure to allergens
proper diagnosis
Proper Diagnosis
  • Diagnosis requires a thorough medical history, physical examination, and laboratory tests
  • Having symptoms is not a diagnosis
    • Symptoms exactly like those of an allergy many not be caused by one
proper diagnosis17
Proper Diagnosis
  • Methods for diagnosis
    • Skin-prick test
    • Antibody blood testing
    • Oral Food Challenges
    • Elimination Diets
rast or elisa
  • Radioallergosorbent test (RAST) or enzyme-linked immunosorbent assay (ELISA) are reliable skin-prick testing and antibody blood testing for diagnosing allergies
proper diagnosis19
Proper Diagnosis
  • Food changes and elimination tests should be conducted only under medical supervision
unreliable methods
Unreliable Methods
  • Two unreliable methods for diagnosing food allergies are cytotoxic testing and symptom provocation testing, where a dose of the food extract is placed under the tongue or injected
most common food allergies
Most Common Food Allergies
  • Food allergies can occur to almost any food, but most allergic reactions are caused by a limited number of foods

milk shellfish

eggs soy

wheat peanuts

fish tree nuts like walnuts

living with a food allergy
Living With A Food Allergy
  • The only proven treatment for a food allergy is to avoid the offending food
  • An elimination diet must be carefully developed and be personalized to take into account the ability of an individual to tolerate an allergic food
living with a food allergy23
Living With A Food Allergy
  • Using an elimination diet for 1-2 years may promote outgrowing a food allergy
  • Some food allergies, particularly to peanuts, nuts, fish and shellfish can last a lifetime
living with a food allergy24
Living With A Food Allergy
  • No drugs are available to treat food allergies
  • Allergy shots, which are useful in desensitizing some people to pollen and other environmental allergens, are not recommended to treat food allergies and may be dangerous
living with a food allergy25
Living With A Food Allergy
  • People with food allergies need to learn about food composition and how to read labels
    • Many foods may contain the allergen
    • Many terms used to describe food components
milk allergy
Milk Allergy
  • Milk and milk products are a common ingredient in many foods so food labels need to be checked carefully
milk allergy27
Milk Allergy
  • Foods containing milk or milk products
    • Milk
      • Acidophilus, buttermilk, chocolate milk, evaporated milk, condensed milk, sweetened condensed milk, malted milk,
      • *Goat’s milk protein similar to cow’s milk protein, may cause similar symptoms, not a recommended substitute
    • Cheese
    • Ice cream
    • Sherbet
    • Yogurt
    • Custard
    • Pudding
    • Eggnog
milk allergy28
Milk Allergy
  • Foods containing milk or milk products
    • Cream, half & half cream, light cream, whipping cream
    • Sour cream, sour cream solids, sour cream dressing
    • Butter, butter oil, butter fat, artificial butter flavor
    • Nougat
    • Mellorine
    • Curds
    • Semi-sweet chocolate, milk chocolate
    • Caramel, creamed, carob candies
milk allergy29
Milk Allergy
  • Terms for milk products
    • Casein
    • Rennet casein
    • Amoniumcaseinate
    • Calcium caseinate
    • Magnesium caseinate
    • Potassium caseinate
    • Sodium caseinate
    • Casein hydrolysate
    • Milk protein hydrolysates
    • Protein hydrolysate
milk allergy30
Milk Allergy
  • Terms for milk products
    • Lactose
    • Lactablumin
    • Lactalbumin phosphate
    • Lactoglobulin
    • Lactulose
    • Milk protein
    • Whey
    • Whey protein concentrate
    • Whey protein hydrolysate
    • Sweet whey
    • Delactosed whey
milk allergy31
Milk Allergy
  • Ingredients potentially containing milk or milk products
    • Caramel flavoring
    • Bavarian cream flavoring
    • Coconut cream flavoring
    • Brown sugar flavoring
    • Butter flavoring
    • Natural flavoring
    • Simplesse®
egg allergy
Egg Allergy
  • Eggs and egg proteins are common ingredient in many foods so food labels need to be checked carefully
  • Because flu vaccines are prepared using egg embryos, people with egg allergies need to check with their physicians before being vaccinated
egg allergy33
Egg Allergy
  • Eggs or foods containing egg products
    • Eggs, egg white, egg yolk
    • Dried eggs, frozen eggs, powdered eggs, egg solids
    • Egg substitutes
    • Imitation egg product
    • Béarnaise sauce
    • Hollandaise sauce
    • Eggnog
    • Mayonnaise
    • Meringue
    • Simplesse®
egg allergy34
Egg Allergy
  • Terms for egg or egg products
    • Albumin
    • Apovitellin
    • Avidin
    • Egg lecithin
    • Flavoprotein
    • Globulin
    • Livetin
    • Lysozyme
    • Ovalbumin, conalbumin
    • Ovomucin
wheat allergy
Wheat Allergy
  • Wheat is a common ingredient in many foods so food labels need to be checked carefully
wheat allergy36
Wheat Allergy
  • Wheat or wheat products
    • Atta wheat flour
    • Bal ahar
    • Bread flour
    • Bulgur
    • Cake flour
    • Cereal extract
    • Courscous
    • Cracked wheat
    • Durum
    • Durum flour
wheat allergy37
Wheat Allergy
  • Wheat or wheat products
    • Enriched flour
    • Farina
    • High protein flour
    • Kamut flour
    • Laubina
    • Lechealim
    • Malted cereals
    • Minchin
    • Multi grain breads
    • Multi grain flours
wheat allergy38
Wheat Allergy
  • Wheat or wheat products
    • Puffed wheat
    • Red wheat flakes
    • Rolled wheat
    • Semolina
    • Shredded wheat
    • Soft wheat flour
    • Spelt
    • SuperArmine
    • Triticale
    • Vital gluten
wheat allergy39
Wheat Allergy
  • Wheat or wheat products
    • Vitalia macaroni
    • Wheat protein powder
    • Wheat bran
    • Wheat germ
    • Wheat gluten
    • Wheat meal
    • Wheat pasta
    • Wheat protein
    • Wheat starch
    • Wheat tempeh
wheat allergy40
Wheat Allergy
  • Wheat or wheat products
    • White flour
    • Whole wheat berries
    • Whole wheat flour
    • Winter wheat flour
wheat allergy41
Wheat Allergy
  • Ingredients potentially made from wheat
    • Hydrolyzed vegetable protein
    • Vegetable starch
    • Starch
    • Gelatinized starch
    • Modified starch
    • Modified food starch
    • Vegetable gum
peanut allergy
Peanut Allergy
  • Some people with peanut allergies have severe reactions, including anaphylaxis, to the smallest quantities of peanuts
  • Although peanut allergy is not ordinarily associated with other nut allergies, people may be advised to avoid all nuts due to potential cross-contamination
peanut allergy43
Peanut Allergy
  • Peanuts, peanut products, foods containing peanuts
    • Beer nuts
    • Eggrolls
    • Ground nuts
    • High protein food
    • Hydrolyzed plant protein
    • Hydrolyzed vegetable protein
    • Marzipan
    • Mixed nuts
    • Nougat
peanut allergy44
Peanut Allergy
  • Peanuts or peanut products
    • Peanuts
    • Peanut flour
    • Peanut soup
    • Peanut butter
    • Peanut oil
    • Peanut flakes
peanut allergy45
Peanut Allergy
  • Products that may contain peanuts
    • Pie crusts
    • Cheese cake crusts
    • Chocolate candy
    • Ice cream
    • Baked goods
    • Sauces
    • Chili
    • Candy
other types of food reactions
Other Types Of Food Reactions
  • Some people have adverse reactions to foods that do not involve the immune system
  • These are referred to as "food intolerances“ they are not food allergies
causes of food intolerances
Causes of Food Intolerances
  • Food intolerances may be caused by:
    • Enzyme deficiencies
    • Reactions to chemicals in foods
    • Sulfur
    • Digestive diseases
metabolic intolerances
Metabolic Intolerances
  • A metabolic intolerance is when the body cannot adequately digest a portion or component of a food
  • For example lactose intolerance and gluten intolerance
lactose intolerance
Lactose Intolerance
  • People with lactose intolerance cannot digest (breakdown) lactose in milk
  • Lactose is a disaccharide (sugar) in milk
  • Lactose is digested by the enzyme lactase into two monosaccharides, glucose and galactose, which can be absorbed by the small intestine
lactose intolerance50
Lactose Intolerance
  • If there is not enough lactase, the lactose is goes undigested the intact lactose moves into the large intestine and is fermented by normal bacteria found in the large intestine
  • The amount of lactase produced tends to decrease in adulthood
  • Incidence of lactose intolerance varies for different populations.
symptoms of lactose intolerance
Symptoms Of Lactose Intolerance
  • Symptoms include cramps, bloating, intestinal gas, diarrhea and nausea
  • Severity of symptoms varies with the amount of lactose consumed and degree of intolerance
  • Symptoms appear from 15 minutes to several hours after eating foods or beverages containing lactose
is lactose intolerance a milk allergy
Is Lactose Intolerance A Milk Allergy?
  • A milk allergy is an allergic reaction to the protein components in milk, not the lactose in milk
  • People with milk allergy usually must avoid all milk products. People with lactose intolerance can use certain dairy products that are low in lactose
how much lactose
How Much Lactose
  • Amount of lactose allowed depends on the degree of lactose tolerance
    • Many can tolerate 6 grams lactose (1/2 C milk)
    • Many can tolerate fermented products such as yogurt and acidophilus milk
    • Hard cheeses and cottage cheese may be tolerated because most of the lactose is removed with whey
how much lactose54
How Much Lactose
  • Many foods contain small amounts of lactose, for example breads, dry cereals, cold cuts, cream soups, salad dressings, candy, cookies, drink mixes, and sugar substitutes
  • Most people can handle the small amount of lactose in these foods
how much lactose55
How Much Lactose
  • Very sensitive people need to check food labels carefully for:
    • Milk
    • Whey
    • Lactose
    • Nonfat milk solids
    • Dry milk solids
    • CurdsCheese
    • Margarine
    • Sweet or sour cream
  • Many people can use commercially prepared milk products that have been treated with an enzyme (lactobacilus) that breaks down lactose
  • Alternatively, people can take enzyme tables with meals or add enzyme drops to their milk
    • Example: Lact-aid, Dairy-ease, Lactinex
gluten intolerance
Gluten Intolerance
  • Gluten is a protein found in wheat, rye, and barley or derivatives of these grains such as malt
  • Some individuals cannot tolerate the gliadin fraction in gluten
gluten intolerance58
Gluten Intolerance
  • Gluten intolerance is also referred to as celiac disease, celiac-sprue, nontropical sprue or gluten sensitive enteropathy
  • Individuals do not outgrow gluten intolerance
symptoms of gluten intolerance
Symptoms Of Gluten Intolerance
  • As a result of gliadin intolerance the intestinal lining is flattened which results in reduced food absorption, diarrhea, steatorrhea (fat in the stool), bloating, loss of appetite, muscle wasting, weight loss and can lead to progressive malnutrition
symptoms of gluten intolerance60
Symptoms Of Gluten Intolerance
  • Lactose intolerance may temporarily occur secondarily to gluten intolerance
  • However, lactose containing foods can be returned to the diet within a short time
gluten intolerance61
Gluten Intolerance
  • Gluten containing grains
    • Wheat
    • Rye
    • Barley
  • Oats
    • Although oats is gluten-free, the use of oats is controversial due to contamination with wheat during processing
    • A limited intake of oats (40 to 60 g/day) is currently considered acceptable
gluten intolerance62
Gluten Intolerance
  • Non-gluten containing grains
    • Tapioca
    • Corn flour
    • Corn starch
    • Rice flours
    • Potato starch
    • Potato flour
    • Soy flour
gluten free flour substitute
Gluten-Free Flour Substitute
  • Gluten-free flour mix

Rice flour 6 cups

Potato starch 2 cups

Tapioca flour 1 cup

food additive intolerances
Food Additive Intolerances
  • Although most individuals consume a wide variety of food additives each day, only a small number have been associated with intolerances to food additives
yellow no 5 or tartrazine sensitivity
Yellow No. 5 or Tartrazine Sensitivity
  • Yellow No. 5 is a food color additive
  • Although rare, yellow dye No. 5 may cause hives in some individuals
  • Whenever Yellow No. 5 is added to a food, it should be listed on the product food label
carmine sensitivity
Carmine Sensitivity
  • Carmine is an extract of the cochineal insect used as a bright red dye in a number of products
  • Occasional reactions to carmine used as a food coloring have been reported
  • If carmine is added to a food it should be listed on the product food label
monosodium glutamate msg
Monosodium glutamate (MSG)
  • MSG is a flavor enhancer
  • MSG is the sodium salt of glutamic acid, an amino acid found naturally in all protein
  • A few people report mild and short-lived reactions after eating MSG
  • If MSG is added to a food it is listed on the label as monosodium glutamate
  • Sulfites are used to preserve color of foods and inhibit microorganism growth
  • Some people develop shortness of breath or fatal shock shortly after exposure to sulfites
  • Sulfites can produce severe asthma attacks in sulfite-sensitive asthmatics
  • FDA banned the use of sulfites on fresh fruits and vegetables (except potatoes) intended to be sold to consumers raw
  • Sulfites added to all packaged and processed foods must be listed on the product label
  • Some people have complained of adverse reactions to aspartame
  • However, in clinical studies aspartame has not shown allergic reactions
  • FDA concluded there is no evidence of a cause and effect between aspartame and sensitivities reported