Food Allergies, Celiac Disease & Food Intolerances

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Life is Not Simple

What to Study

• You are responsible for understanding the material presented in lecture and powerpoint

• You are not responsible for additional textbook material

• However, reading the text unit may enhance your understanding.

Questions

• What is the difference between food allergies, intolerances, and other reactions?

• What are the most common food allergens?• How many people have food allergies?• How are they treated?• How serious are they?

Food Allergy Confusion

• People use term “food allergy” for any food problem

• Food allergies now a health concern in U.S.

• Real ones are usually serious

• Can cause a rash or upset stomach

• Can result in death

Food Allergies

• Imagined food allergies lead to inadequate diets and other health problems

• Many foods are falsely blamed for mental and physical health problems

• People sometimes blame allergies for hyperactivity in children

Adverse Reactions to Foods

• Adverse reactions to food:

• food poisoning: not our topic today

• food allergies: immune system reacts to a substance in food (usually a protein)

• food intolerances - all others– Immune system not involved in food

intolerances (all other adverse reactions)

Allergic Response

• Cells recognize food components; ones that trigger the immune system are food allergens

• Exposure to an allergen triggers an allergic reaction

• Immune system forms antibodies

• Antibodies attach to cells

Allergic Response

• If allergen reappears, antibodies attach to it, and signal body to secrete histamine and substances that cause physical signs of allergic reactions

• Allergic reactions cause rash, diarrhea, congestion, or wheezing, or may be more serious

Symptoms

Anaphylactic Shock

• Can result in death, caused by cutoff of blood supply to tissues or air to lungs

• Signs: Hoarseness, throat tightens, feels like

– A lump in the throat

• Wheezing, chest tightness or difficulty breathing

• Tingling in the hands or feet, lips or scalp

Anaphylactic Shock

• Most likely from allergen in peanuts, fish, and shellfish

• Incidence of peanut allergy is increasing - 1 in 100 people affected

• Symptoms occur in seconds after exposure– or up to two hours

• Symptoms often disappear within two hours (if person survives)

Morbidity and Mortality

• Approximately 30,000 consumers require emergency room treatment yearly

• About 150 Americans die each year because of allergic reactions to food.

Top 8 Food Allergies

Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA)

• Effective January 1, 2006, FDA required food labels to clearly state if food products contain any ingredients that contain protein derived from the eight major allergenic foods…in plain English

• milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients OR to say "contains" followed by name of the source of the food allergen

Label Reading: Essential

• Milk proteins: Casein, caseinates, rennet casein, Lactalbumin, lactalbumin phosphate, lactoglobulin, lactulose

• Egg protein: Albumin or albumen

• Meringue or meringue powder

• Egg protein may be in– Artificial flavors, lecithin, macaroni, marzipan,

marshmallows, nougat, pasta

Peanuts• Artificial nuts, beer nuts, ground nuts, mixed nuts, nut

pieces

• Peanut butter, peanut flour

• May be in any foreign foods.. Baked goods, candy, chili, egg rolls, enchilada sauce, flavorings, and sunflower seeds..

• Now, just look at

• label for allergens:

Are Food Allergies Common?

• Infants and young children have food allergies more often adults

• 8% of infants and young children develop a food allergy,

• The tendency to food allergies is genetic• Most infants outgrow allergy to cow’s milk, egg white,

wheat, and soy• Rarely outgrow allergies to peanuts, nuts, fish, and

shellfish

Are Food Allergies Common? Can They be Prevented?

• AAP Year 2000• Recommendations• for families with

allergies– Cow’s milk and

allergenic foods like peanuts, nuts, fish, seafood, eggs, and wheat not recommended for infants during the first one to three years

• AAP 2013 Recommendations

• After 4 to 6 months of age, there is not enough data to support dietary restrictions!

• American Academy of Pediatrics

Are Food Allergies Common?

• Incidence of food allergies in adults ~2% and increasing

• Reasons for this increase are unknown

• But over 30% believe they have food allergies• They may have an intolerance or• They may be avoiding foods unnecessarily

Diagnosis

• A variety of tests are used to diagnose food allergies, but there is only one “gold standard” for most allergies- that test is the double-blind, placebo-controlled food challenge

• Exception: celiac disease/gluten allergy

Skin Prick Tests

• Skin prick tests common and useful for identifying the absence of a food allergy

• Positive test results inaccurate 50% of the time

• Few drops of food extract placed on the skin and skin is then pricked with a needle

Skin Prick Tests

• At same time, another area of skin is pricked using water

• Area around food skin prick more swollen than control means person might be allergic

• Skin prick tests are useful to rule out allergies

Blood Tests

• RadioAllergo• Sorbent (RAST)Test • ELISA/EIA Test • Quality control issues• in laboratories • Does not reliably indicate

a food allergy• Mailed diets often poor

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American Academy of Allergy, Asthma and Immunology:

Bogus Tests• Tests …for which there is no evidence of validity

include provocation-neutralization, cytotoxic tests, muscle response testing (applied kinesiology), electrodermal testing, the “reaginic” pulse test, and chemical analysis of body tissues.

• Measurement of specific IgG antibodies to foods is also unproven (blood tests)

Treatment

• Identify food allergy• Eliminate food from the diet

– Only "treatment" available for food allergies

• If the food is important source of nutrients, consultation with a registered dietitian is recommended

• Most children with allergies to peanuts, nuts, fish, or seafood need to avoid the food for life

Precautions

• People with severe allergies should carry preloaded syringe of epinephrine (“epipen”) and know how to use it

• Know where to call for emergency help• Keep asthma inhalers and antihistamines readily

available

Celiac Disease

• AKA gluten allergy – gluten intolerance

• Triggered by consumption of gluten

• Gluten is the main protein in wheat

• Gluten is naturally found in wheat, barley, and rye

Celiac Disease

• Autoimmune reaction to gluten

• Affects about 1 in 100 people– More common today

• Intestinal villi are severely damaged

Celiac Disease

• Damaged villi do not effectively absorb nutrients

• After exposure to gluten, recovery time is measured in weeks or months

Celiac Disease

• Genetic • May occur in infancy• Or may become active

later due to viral infection, or other physical or emotional stress.

Celiac disease- Symptoms• Severe flatulence (gas), abdominal bloating and pain

• chronic diarrhea and/or constipation

• weight loss/weight gain

• fatigue

• unexplained anemia

• bone or joint pain

• muscle cramps

• Headaches, migraines

• delayed growth in children

• failure to thrive in infants

Celiac Disease-ScreeningTissue Transglutaminase Antibodies

• Blood test screens for tTG-IgA

• must be on a gluten-containing diet for at least a month

• Test will be positive in about 98% of people with celiac disease

Celiac Disease-DiagnosisEndoscopic Biopsy

• For accurate results must be eating gluten (at least 4 slices of bread per day)  for one to three months prior to the procedure.

• http://celiac.org/

Celiac Disease: Treatment

• Avoid gluten• naturally in wheat,

rye, and barley.• Avoid most grain,

pasta, cereal, and many processed foods.

Celiac Disease: Treatment

• Avoid flours of corn, oats and rice

• These grains are naturally gluten-free– But often processed in factories that also

manufacture wheat products, so are contaminated.

• Avoid unless label says "gluten-free."

Celiac Disease: Treatment

• What does “gluten-free mean?

• August 5, 2014, FDA rule went into effect: limit of less than 20 ppm (parts per million) of gluten in foods that carry this label.

Examples: okay

• Corn on the cob, canned corn, or popcorn-- but not cornmeal unless label says "gluten-free"

• Corn Starch- label should say "gluten-free"– substitute for flour when you make gravy or need a

thickener

• Whole brown rice okay– but not rice cereal unless label says "gluten-free"

Label Reading Essential

• Hidden sources of gluten:

• Additives like modified food starch, preservatives, and stabilizers

• Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods.

• Example: regular soy sauce has gluten

Special Foods

• Gluten free bread

• Gluten free flour

• Gluten free pasta

• Gluten free cake …

• And Potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour if processed without exposure to gluten.

Grains & StarchesNaturally Gluten-Free

• Amaranth • Buckwheat• Corn, corn pone,

polenta• Potatoes• Quinoa• Rice

• Okay if whole grain • Or fresh• But if processed in

factories that run wheat, barley or rye, they are no longer gluten-free.

• Look for the label.

Grains & StarchesNaturally Gluten-Free

• Oats • But often, oats and wheat are rotated in the field (the farmer grows wheat one year and oats the next). Some wheat grows in with the oats, so the harvested oats are not gluten-free.

• Look for the label– make sure it says gluten-free.

Eating Out

• Enjoying a meal at a restaurant can be difficult, although more restaurants now have gluten-free foods on the menu.– Are the foods really gluten free when they get to the

plate? Good question!

• Eating with friends and family can also be problematic. It's not an easy diet for people to understand.–

More on Shopping

• In Spartanburg, Garner's Health Foods– And Publix have the best selection

Celiac Disease: Cure? None at present

Food Intolerances

• Food intolerance reactions do not involve the immune system; due to a missing enzyme or other cause

• Some are intolerant of lactose, sulfite, histamine• Separate real from unreal by double-blind, placebo-

controlled food challenge• True food intolerances produce predictable reactions• Headache, diarrhea, swelling, or stomach pain occur

every time a person consumes a suspected food

Sulfite Sensitivity

• Sulfite is a food additive used to keep vegetables and fruits looking fresh and to prevent mold growth

• Added to beers, wines, processed foods, and medications as a preservative

• Small amounts bring on asthma and can cause anaphylactic shock in sensitive people

Table 17-3, p. 9

Histamines and Migraines

• Some get migraine headaches from red wine• Histamine in wine causes the headaches• Some people can’t break it down in digestive tract;

it accumulates in blood & causes headaches• Histamine also in beer, sardines, anchovies, hard

cured sausage, pickled cabbage, spinach, and catsup

Tyramine

• Tyramine is relatated to histamine

• In aged cheese, soy sauce, fermented products, this can cause migraines in sensitive people

Phenylethylamine

• Phenylethylamine may be a migraine or headache trigger for people who get headaches from chocolate

Sometimes, it takes more than one “trigger” to cause a headache

Precautions

• People with food problems must be careful

• Should have plan ready if they develop reaction

• Eating out, ASK what is being served

• Keep asthma inhalers and antihistamines readily available

• People with severe allergies should carry “epipen” and know how to use it

• Know where to call for emergency help

• ENDEND