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Food Allergies in Infants and Children
• Shana Spector
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Food Allergies in the U.S.
• More than 6 million Americans suffer from food allergies
• 3 million specifically allergic to peanuts, walnuts, and pecans
• Other common food allergies: milk, fish, shellfish, wheat and soy
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What Causes Allergic Reactions?
• Overactive immune system
• Body believes a substance is harmful
• Body wants to protect itself by fighting that substance off
• Immune system releases chemicals and histamine, triggering the reaction
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IgE Mediated Allergy Disorder
• Cause acute onset of symptoms after digestion
• Affect skin, respiratory tract, gastrointestinal tract and cardiovascular system
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IgE Mediated Allergy Disorder
• IgE antibodies are cells that are released from specialized B cells during contact with allergen
• IgE antibodies attach to IgE receptors on mast cells
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IgE Mediated Allergy Disorder
• If the allergen is again presented in the body, it binds to surface of mast cell, triggering release of histamine and other chemicals
• Picture and animation
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Types of IgE Mediated Disorders
• Type 1 Hypersensitivity: most common disorder
• Symptoms include hives, swelling of face, itching, vomiting, diarrhea, coughing, wheezing and decrease in blood pressure
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Types IgE Disorders
• Oral Allergy Syndrome
• Caused by allergies to fruits and veggies
• Itching swelling of lips, tongue, palate and throat
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Types IgE Disorders
• Respiratory Hypersensitivity Reaction
• Effects respiratory tract
• Causes runny nose, nasal congestion, wheezing and coughing
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Types IgE Disorders
• Airborne Food Allergy Reaction
• Transpires from smelling an allergen through cooking
• Causes nasal congestion, inflammation of the eyes and hives
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Types IgE Disorders
• Food-Associated Exercise-Induced Anaphylaxis
• Occurs when allergic person exercises 2-4 hours after eating certain foods
• No reaction without exercise
• More common in females (esp. teenagers)
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Other Food Disorders
• Subacute or chronic
• Usually affect gastrointestinal tract
• Mediated by T cells
• Mainly found in infants and children
• Usually caused by hypersensitivity to cow’s milk or soy
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Symptoms of Food Allergies
• Hives are most common
• Other symptoms: tingling in mouth, swelling in the tongue and throat, difficulty breathing, abdominal cramps, vomiting, diarrhea, and eczema
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Anaphylaxis
• Serious allergic reaction occurring within a few minutes to two hours after contact with allergen
• Acute and potentially fatal
• Causes 300,000 hospital visits and 150-200 deaths per year
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Infants, Children and Food Allergies
• 6-8% of children develop food allergies within the first three years of life
• 90% of food allergies in kids involve cow’s milk, egg, peanut, wheat, soy, tree nuts, or fish
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Infants, Children and Food Allergies
• Most children outgrow their allergies to milk, egg, wheat and soy by age 3-5
• Only 20% of infants with peanut allergy will eventually tolerate peanuts
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Problems Associated with Food Allergies in Children
• Poor nutrient intake
• Constipation
• Eczema
• Potential death
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Food Allergies Linked to Poor Growth
• Increased risk for poor nutrient intake
• Parents may eliminate too many foods from child’s diet or neglect to supplement
• In severe cases, children can develop failure to thrive
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Studies Showing Poor Growth
• Children with one or more food allergies more likely to be under 25th percentile height for age than healthy children
• Subjects with 2 or more food allergies significantly shorter than children with 1
• Children with specific allergy to cow milk showed lower height for age than healthy children
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What to do if Child has Food Allergies
• Consult with an allergist and dietician
• Use growth charts often to assess child’s growth
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Food Allergies and Constipation
• Recent studies have linked infantile constipation to cow’s milk allergy
• Study shows infants switching to soy milk from cow milk alleviates constipation
• Study shows 5 year olds eliminating milk protein from diet and no longer suffering from constipation
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Food Allergies and Atopic Dermatitis
• Atopic dermatitis: skin condition associated with food allergies in infants and children
• Atopy: refers to a tendency for excess inflammation in the skin, linings of the nose, and lungs
• Eczema usually runs in families
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Food Allergies and Eczema
• 10% of infants suffer from eczema
• Skin becomes infected, with itchy rashes on face and scalp
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Food Allergies and Eczema
• Study suggests that introducing solid food later in life will decrease prevalence of eczema
• Low-birth weight significantly correlated with a lower risk for food allergies and atopic dermitis
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Potentially Deadly Reactions
• Most severe reactions in children: peanuts and other tree nuts
• Many are accidental: hidden nuts in brownies and cookies, peanut oil, etc.
• Symptoms progress with maturity
• Skin reaction during infancy to respiratory and gastrointestinal reactions later
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Maternal and Familial Influence on Food Allergies
• Food allergies and atopy run in families
• 20% of children with eczema are the only one in family with problem
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Maternal Influence and Possible Prevention
• Prevalence of peanut allergy is rising
• Pregnant women advised to eliminate peanuts from diet
• Allergy to peanuts may be preventable
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Breastfeeding Mothers
• Breastfeeding may prevent food allergies and atopic dermatitis
• Can pass peanut allergy through breastfeeding
• It is recommended for mom to eliminate peanuts from diet while breastfeeding
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Prevention of Cow’s Milk Allergy
• Hydrolysated formula
• Extensive or partially
• Only given to babies at high risk for atopic disease due to family history
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Prevention of Cow’s Milk Allergy
• Babies given eHF combined with breast milk and no solid food until after 6 months of age
• Prevalence of food allergy and atopic dermatitis significantly reduced
• Babies given eHF or pHF: atopic disease greatly reduced in those given eHF
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Diagnosis of Food Allergy
• What happens in the case of a mild reaction?
• What happens in the case of a severe reaction?
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Tests and Procedures to Determine Food Allergy
• Skin Prick Test
• Identifies food specific IgE antibodies
• Test is either negative or positive
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Tests and Procedures to Determine Food Allergy
• Radioallergosorbent Test (RAST)
• Done if test positive on SPT
• RAST is a blood test to determine food specific IgE
• RAST and SPT detect sensitization, but sensitization can occur without reaction
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Elimination Diet
• Determines if given food is causing allergic reaction
• Food thought to be causing symptoms removed from diet
• Infants: change of formula or diet for breastfeeding mother
• Lasts 1-6 weeks
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Food Challenge
• Also determines if specific food causes allergic reaction
• Performed under certain circumstances:
1)When several foods are under consideration, 2)IgE tests positive for several foods, and 3)elimination diet caused symptoms to end
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Relevance to Parents
• Valuable for new parents and those thinking about reproducing
• May be able to prevent certain food allergies• Be aware: unusual symptoms of child may be
caused by food allergy• Education is Key: inform teachers, babysitters,
and any caretaker of child in order to prevent severe reactions