Food Allergies
Food Allergies
Food Allergies
Food Allergy statistics:
11 million Americans, including adults
6% of US children
2% of adults have shellfish allergy
True Prevalence of Food Allergy Patient/Parent Self Report = 12 - 14%
Based upon History & Testing = 3%
Food Allergies
Common food allergens:
Cow’s milk
Egg white
Soy
Peanut
Tree nuts
Shellfish
Fish
Wheat
Natural History of Food Allergy
Dependent on allergen
- Most children outgrow milk, egg, soy & wheat
allergy
- Less common to outgrow peanut or tree nuts
- Seafood allergies often develop in adults &
persist
Age
- Food allergy that starts in adults is unlikely to
resolve
Food Allergies
Symptoms of an allergic reaction:
Skin
Gastrointestinal
Respiratory
Neurological
Anaphylaxis (or a severe allergic reaction)
Skin:
hives
Gastrointestinal:
vomiting
diarrhea, abdominal pain
Respiratory:
wheezing, cough
chest tightness
throat tightening
Neurological: anxiety sense of “doom”
Food Allergies
Diagnosis:
Medical history
type of reaction can vary based on: • Amount ingested
• Type of food
• Previous reactions
• Age of child
timing
treatment
Physical exam
Food Allergies
Treatment:
Education, education, education
Anaphylaxis
Specific food avoidance/nutrition support
Medications: injectable epinephrine
• Epi Pen Junior
• Auvi-Q
Food allergy action plan
Adjusting to daycare and/or school
Treatment of Reactions
For reactions isolated to the skin Antihistamine (such as Benadryl®, cetirizine or Zyrtec®)
Close monitoring for additional symptoms
For airway involvement, vomiting, or other symptoms of a severe reaction (anaphylaxis) Injectable epinephrine
• Delayed epi administration is a risk factor for death
After epinephrine use, seek immediate care (911) Late phase reactions occur up to 20% of the time
• Important to have 2 epinephrine devices available
At least 4 hrs of observation recommended in emergency department
*Jarvinen, JACI 2008
Food Allergies
Treatment (con’t):
Ongoing care by Primary Care
Annual visits to allergy:
Monitor growth, food exposures, reactions
Education
Repeat testing
Evaluate for food challenge
Management in Schools*
25% of anaphylaxis occurs in schools in child without previous diagnosis Unassigned Epi should be considered
Emergency action plans: Provider → Parent → School Health → School Staff
Antihistamines: “adjunctive therapy” – not to treat anaphylaxis
Epinephrine safe: “when in doubt, inject.”
Medical alert ID (young children)
*Clinical Report – Management of Food Allergy in the School Setting, AAP 2010
Management in Schools*
Peanut butter vapors ≠ protein
Foods can be vaporized through heating
→ respiratory symptoms
Cleaning in classroom: soap/water; NOT
antibacterial gels “standard cleaning & lack of visible contamination should
suffice…”
Care not to ostracize/physically separate FA
child
*Clinical Report – Management of Food Allergy in the School Setting, AAP 2010
Management in Schools*
Reducing risk of accidental exposure:
No food sharing
Education of parents/staff (injectable epi use,
when to call EMS)
Plans for field trips
Label-reading
No eating on school bus
Harassment/bullying
*Clinical Report – Management of Food Allergy in the School Setting, AAP 2010
Impact on Quality of Life
Children & caregivers with significant anxiety due to risk
50% alter social activities & 10% home-schooled due to food allergy1
60% food prep altered
Children’s self report of quality of life similar to Type I diabetes2
1 Bollinger, Annals of Allergy 2006
2 Avery, Pediatric Allergy 2003
Food Allergies
Additional Facts:
Only 20% of fatal reactions had experienced a prior “severe” reaction*
Patients ill prepared for reaction*
< 20% have injectable epinephrine available
< 20% pediatricians know how to administer epinephrine correctly*
* Dr. Hugh Sampson, oral presentation, Wisconsin Allergy Society Meeting, October
2006
Online Resources
Food Allergy & Anaphylaxis Network (FAAN) www.foodallergy.org
American Academy of Allergy Asthma & Immunology (AAAAI) www.aaaai.org
Guidelines for the Diagnosis & Management of Food Allergy in the US: Report of the NIAID-Sponsored Expert Panel. Dec. 2010
Clinical Report – Management of Food Allergy in the School Setting. AAP. 2010