Food Allergy: Separating Fact from Fiction

Stephanie Albin Leeds, MD(Slides adapted from Mount Sinai Jaffe Food Allergy Institute)

March 31, 2016

Topics that will be covered:

-Food Allergy Basics-Anaphylaxis Basics-Myths and Facts

Food Allergy Basics• A food allergy is an abnormal immune response to a food

protein.

• A food allergy results in an activation of the immune system when a food protein is ingested, leading to the release of histamine and other mediators to “attack” the food.

• A food allergy presents with allergic symptoms typically within minutes to hours after ingestion.

• A food allergy can come from almost any food.

Increased Prevalence of Food Allergies

• From 1997 to 2007, the prevalence of reported food allergy increased 18% among children under age 18 years.1

• From 2004 to 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergy among children under age 18 years.1

1. NCHS Data Brief; Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations. http://www.cdc.gov/nchs/data/databriefs/db10.pdf. Accessed February 17, 2016.

Food Allergies Can Be Life-Threatening

• There were about 2500 anaphylaxis-related deaths in the United States from 1999-2010; most common cause was medication (58.8%), followed by unspecified (19.3%), venom (15.2%), and food (6.7%)2 – however, food is most common cause of anaphylaxis in pediatric population.

• It is estimated that up to 150-200 people die each year from food-induced anaphylaxis.

2. Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States, 1999-2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014 Dec;134(6):1318-1328.e7.

Food Allergy Basics• There is no cure for food allergy– current research is looking

into immunotherapy (oral, sublingual, and epicutaneous), but there are no FDA approved interventional therapies at this point.

• Complete and strict avoidance is the only way to prevent a reaction. Just one bite can cause a reaction.

Myth or Fact Strawberries are a common cause of life threatening food allergy.

MYTH

Common Food Allergens

Common Food Allergens by AgeChildren 6% affected

Adults 3-4 % affected

Cow’s milk 2.5% Egg 1.3%Peanut 1%SoybeanWheatTree nutsFishShellfish

PeanutTree nutsFishShellfish* Fruits and vegetables in birch-allergic adults (25-75%)

Myth or FactIf my child has only had hives upon eating peanuts, he does not need to carry an EpiPen because he will not have a severe allergic reaction to peanut.

MYTH

Food Allergy Reactions• Once a reaction begins, there is no way to know how severe it will

become

• Take all food allergic reactions seriously

• A previous reaction does not predict what your next reaction will be

Symptoms of a Food Allergic Reaction

Cutaneous Manifestations of Food Allergy

Myth or FactMy egg allergic child with asthma accidentally ate some scrambled egg and 15 minutes later developed wheezing but no other symptoms. I should give him an EpiPen.

FACT

Anaphylaxis Basics • Anaphylaxis is a severe, potentially life-threatening allergic reaction1. Quick onset of hives/ swelling/ flushing AND AT LEAST ONE OF THE FOLLOWING• Respiratory symptoms (wheezing, coughing, difficulty breathing)• Reduced blood pressure/ passing out2. Two or more affected organ involvement after likely allergen exposure• Skin (hives/swelling/flushing)• Respiratory (wheezing/coughing/difficulty breathing)• Cardiovascular (blood pressure drop)• Persistent GI symptoms (recurrent vomiting)3. Low blood pressure after ingesting a known allergen

Anaphylaxis Basics• Symptoms can being within minutes or up to 2 hours after eating a

food

• For some people, symptoms will begin as soon as the food enters their mouth, even if they don’t swallow the food

• Anaphylaxis does not result from smelling food- but it has been reported from inhaling fumes during the cooking of allergen-containing food

Anaphylaxis Treatment• Intramuscular epinephrine- EpiPen or Twinject (all Auvi-Qs have been

recalled): PROMPT ADMINISTRATION IS KEY TO SURVIVING ANAPHYLAXIS. FATALITIES HAVE RESULTED FROM A DELAY/FAILURE TO GIVE EPINEPHRINE.

• Call 911 and follow up in emergency department

• If patient is not improved 3-5 minutes after first epinephrine injection, give a second injection while waiting for 911 responders

• 4 hour observation period

3 Rs of an Anaphylaxis Plan

•Recognize symptoms early

•React quickly

•Review what caused the reaction

Every school should have a plan for managing allergies!

Myth or Fact My child has food allergies and it is entirely the school’s responsibility to make sure that they are safe from allergic reactions at school.

MYTH

Avoid Accidental Exposure• Read labels…foods, art supplies, soaps• Prevent cross contamination in the classroom or lunch room• Clean hands before and after eating or handling food with soap and

water- hand sanitizers do not remove allergens• In the classroom, serve allergen free foods first-with clean hands or

clean utensils• Plan for safe parties/celebrations/field trips• Prohibit food trading and sharing

Family’s Responsibilities• Provide written medical documentation• Provide properly labeled medications and replace after use or

when expired• Keep emergency contact information up to date• Teach the child age-appropriate self management skills• Work with school to develop a plan

School’s Responsibilities• Create an environment where children, including those with food

allergies, will be safe and included• Employ prevention and avoidance strategies• Be prepared to handle an allergic reaction- create a plan• Address teasing/bullying

Prepare for the Accidental Exposure

• Know the symptoms of an allergic reaction• Review all emergency procedures and be sure you know when and

how to administer medications• Keep information about your allergic student someplace where a

substitute will immediately be aware of it• Test your food allergy plan- have a drill

ResourcesThe Food Allergy Research and Education

800-929-4040www.foodallergy.org

The Food Allergy Initiative212-207-1974

www.faiusa.org

Westchester Health Associates- Allergy and Immunology 1600 Harrison Avenue 281 Garth Road, Suite AMamaroneck, NY 10543 Scarsdale, NY 10583

914-777-1179 914-472-3833