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