Nutritional Considerations in Food Allergy Patients

66 Pages·2016·2 MB·English

Nutritional Considerations
in Food Allergy Patients
Liz Hudson MPH, RD
Objectives
• Brief overview on food allergy
– Food allergen labeling laws
– Nutritional implications
– Cow’s milk allergy
• Discussion on non-IgE mediated food allergies
and their nutritional implications
– Food Protein Induced Enterocolitis (FPIES)
– Eosinophilic Esophagitis in pediatric population
(EoE, EE)
Food Allergy
• Food allergy defined: “an adverse health affect
arising from a specific immune response that
occurs reproducibly on exposure to a given
food.”
–NIAID (National Institute of Allergy and Infectious Diseases)
• Immunoglobulin E mediated (IgE)
• Non-immunoglobulin E mediated (non-IgE)
Overview
.
Source: FARE www foodallergy.org
Food Labeling
• Food Allergen Labeling Consumer Protection Act (FALCPA)
requires food labels to clearly identify the source of
ingredients derived from the following eight major food
allergens in plain language:
– Milk
– Soy
– Wheat
– Egg
– Peanut
– Tree nut (the specific nut must be identified)
– Fish (the specific fish species must be identified)
– Shellfish (the specific species must be identified
FALCPA
Major Ingredients not Products that must Products not
Allergens covered by FALCPA comply with FALCPA covered by FALCPA
Milk Gluten containing grains Food products Raw agricultural
aside from wheat commodities such as
meats, fruits, and
vegetables
Egg Mollusks (clams, oyster, Dietary supplements Alcohol, spirits
scallop)
Wheat All other potential Infant formulas Medications
allergens sesame
Soy Medical foods Cosmetics, soaps,
lotions, shampoos,
etc.
Peanut
Tree nuts
Fish
Shellfish
Source: Groetch, M. Food Allergies: Dietary Management. Practical Gastroenterology. Novemeber2013.
Precautionary Labeling
• Precautionary labeling is voluntary and includes statements
such as:
– “May contain….”
– “Might contain….”
– “Processed in facilities that also process….”
– “Manufactured on equipment that also manufactures….”
– “Manufactured in a facility that processes….”
Advisory Statements: Allergens may be present in foods with
precautionary food allergen statements, so it is best to avoid
packaged foods that have these warnings. Certain manufacturing
practices, such as the use of shared storage containers and
processing equipment can result in residue of allergenic foods
accidentally getting into otherwise safe food products.
Guidance to Patients
• Ingredient Labels:
– Take care to read the entire ingredient list including
any advisory statements such as “contains” or “may
contain.”
• People allergic to foods not included in the top 8
allergens may need to call the manufacturer to
know if ingredients labeled with non-specific
terms such as “spice” or “natural flavoring”
contain a food that should be avoided.
Nutritional Impact and Growth
Concerns
• The US Food Allergy Guidelines recommend
nutrition counseling and regular growth
monitoring for all children with a food allergy
• Comprehensive dietary education should
include:
– How to avoid specific allergens
– Guidance on how to appropriately substitute for
the nutrients typically provided by the eliminated
foods
Nutritional Impact and Growth
Concerns
• Poor growth and inadequate nutrient intake
by food allergy children have been
demonstrated in studies, particularly in
children avoiding milk and/or more than 1
food due to multiple food allergies