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Food Allergies and Implication to
Patient Safety.
Describe the pathophysiology of food allergy. When are many food allergies first diagnosed? - First diagnosed in young children. Your immune system overreacts to a particular protein found in that food. List the eight foods responsible for the majority of allergic reactions. – Eggs Fish Peanuts Shellfish Soy Tree nuts Wheat Cow's Milk Are food allergies and food intolerances the same? Do they often share similar symptoms? Why are food allergies so significant? As nurses, what do we teach our patients with food allergies? triggers a response in the immune system. Food allergy reactions can be life-threatening, so people with this
type of allergy must be very careful to avoid their food triggers. These two share an upset stomach- Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. If you are allergic to a food, this allergen Food intolerance is GI related. Gas, diarrhea, or bloating. does not involve the immune system. Describe cross-reactivity. - Being allergic to a food may also result in being allergic to a similar protein found in something else. Give an example of cross-reactivity. - if you are allergic to ragweed, you may also develop reactions to bananas or melons. This is known as cross-reactivity. What is happening in the immune system when cross-reactivity happens? - Cross-reactivity happens when the immune system thinks one protein is closely related to another. When foods are involved it is called oral allergy syndrome (OAS).
often develops in infancy, usually when a baby is introduced to solid food or formula. What are the most common causes of Food Protein- Induced Enterocolitis Syndrome (FPIES)? - the most common culprits include milk, soy and grains. What is Eosinophilic Esophagitis (EoE) and its most likely cause? Discuss the family history link of EoE. - Eosinophilic Esophagitis (EoE) is an allergic condition causing inflammation of the esophagus. Most research suggests that the leading cause of EoE is an allergy or a sensitivity to particular proteins found in foods. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, dermatitis or food allergy. Describe the reaction when an allergen is ingested. - Your immune system reacts by producing antibodies called Immunoglobulin E (IgE) Where do the antibodies attach? - to cells in your skin, lungs and gastrointestinal (GI) tract
What occurs in subsequent exposures to the allergen? - the cells release chemicals including histamine What are some of the food allergy symptoms that are demonstrated with exposure to the allergen? - which cause food allergy symptoms such as itching, hives, swelling, diarrhea, wheezing and a potentially life-threatening reaction called anaphylaxis What immediate treatment must occur? - An injection of epinephrine and expert care in a hospital What are the differences between a food allergy and a food intolerance? - There is a difference between food allergy and food intolerance. A food allergy involves the immune system while food intolerance, such as lactose intolerance, does not. Food intolerance typically involves the GI tract, causing uncomfortable symptoms like abdominal pain, nausea, vomiting and diarrhea, but there is no risk of anaphylaxis What are the food groups with the most likely cross- reactivity? - most common food allergens are the proteins in cow's milk, eggs, peanuts, wheat,
about the foods you eat, the frequency, severity and nature of your symptoms, and the amount of time between eating a food and any reaction. Describe allergy skin tests. What indicates a possible allergy? Is it likely that a patient with a negative skin test has an IgE-mediated food allergy?
- Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a small amount of extract made from the food is placed on the back or arm. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy. Are there at times false positives with skin and blood tests for food allergy? Discuss the evidence underlying IgE blood testing. - In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend an IgE blood test. False positive results may occur with both skin and blood testing. IgG blood testing is not recommended, as it is unproven in diagnosing food allergies.
What are food challenges? Should food challenges take place at home? - Oral food challenges can confirm the diagnosis and are done by consuming the food in a medical setting to determine if it causes a reaction. Food challenges should not take place at home. Is there a cure for food allergy? What are the keys to managing food allergies? - Nope. Avoidance, education and preparedness are the keys to managing food allergy. What are the risks to exposure to airborne food allergens? What would be likely symptoms? - While exposure to airborne food allergens (e.g., from cooking vapors) usually does not result in anaphylaxis, it can cause a runny nose and itchy eyes similar to a reaction from coming in contact with pollen. What are the risks to eating even a small amount of a food allergen? How does this connect with avoidance plans? - However, eating even a small amount of the food, such as that left on cooking utensils or from a food processing facility, can cause a life-threatening reaction. This is why reading the ingredients on food labels and
What questions should a person with food allergies ask when eating away from home? - Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends Discuss the importance of reading food labels when one has food allergies? - The United States and many other countries require that major food allergens are to be listed in common language (milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soybeans). Review the many important aspects of auto- injectable epinephrine and antihistamines used to treat emergency reactions. When symptoms subside, what action must be taken? - Carry and know how to use auto-injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close to you how to use epinephrine and consider wearing a medical alert bracelet that describes your allergy. If a reaction occurs, have someone take you to the emergency room, even if symptoms subside. Afterwards, get follow-up care from your allergist
Statistically, in Western countries, approximately what percentages of 12-month old infants have a clinically confirmed food allergy? - Up to 10% What is the relationship between vitamin D levels and food allergies levels? - Research using direct measures of vitamin D from blood samples have also shown an association between low vitamin D and increased risk of allergic sensitization in children and adolescents [9] and food allergy in infants [11]. What major roles does vitamin D play in good health? - It plays a major role in the maintenance of healthy bones by helping the body to absorb calcium and also has an essential role in immune system function. Discuss geography and month of birth and incidence of rates of childhood food allergies. - Areas further away from the equator (and thus with lower ambient ultraviolet radiation [UVR]) have been shown to have higher rates of childhood food allergy-related hospital admissions [4], epinephrine auto-injector prescriptions [4, 5], and peanut allergy (up to six times the risk) [6] than areas closer to the equator. Season of birth (being born in autumn or winter when there is
support the idea that vitamin D can protect against food allergies and vitamin D is important for overall good health. What teaching should be included when advising a pregnant woman regarding vitamin D? What is the rationale for that teaching? - If you're pregnant, ensuring you have adequate vitamin D (particularly in late pregnancy) is essential to ensuring your child will have adequate levels. Infants' vitamin D stores in the first year of life rely on the mother's stores before birth. What is the connection between birch tree pollen and apples and celery? Why does this reaction occur in 50-75% of adults with birch tree pollen allergy? What is this called? - symptoms worse, which is referred to as cross-reactivity. In the case of pollen and foods, the result of cross-If you suffer from hay fever (allergic rhinitis) caused by pollen, your mouth or throat may become itchy after eating an apple or celery. This happens in up to 50 to 75% of adults allergic to birch tree pollen. This reaction occurs because the proteins found in some fruits and vegetables are very similar to those found in pollen. These proteins can confuse the immune system and cause an allergic reaction or make
existingreactivity is called oral allergy syndrome (OAS) also known as pollen fruit syndrome (PFS). OAS occurs upon what sort of contact? What are the most common symptoms? When do the symptoms usually appear? At what time of the year does OAS occur? - Upon contact of the mouth and throat with raw fruits or vegetables. The most frequent symptoms of OAS include itchiness or swelling of the mouth, face, lip, tongue and throat. Symptoms usually appear immediately after eating raw fruits or vegetables, although in rare cases, the reaction can occur more than an hour later. OAS is generally considered to be a mild form of food allergy. Rarely, OAS can cause severe throat swelling leading to difficulty swallowing or breathing. In a person who is highly allergic, a systemic reaction, called anaphylaxis (an-a-fi-LAK-sis), may be caused by a pollen cross-reactive raw fruit or vegetable, but this is very uncommon. OAS can occur at any time of the year. Is there a definitive test for OAS? How is OAS determined? - Although there is no definitive test for OAS, affected individuals often have a positive allergy skin test or blood test for
these suggestions? - One way to reduce cross- reactions with food is to bake or microwave the food because high temperatures break down the proteins responsible for OAS. Eating canned food may also limit the reaction. And, peeling the food before eating may be helpful, as the offending protein is often concentrated in the skin. Can allergy shots have impact on symptoms of OAS? - Some studies have shown that treatment with allergy shots can improve the symptoms of OAS. When is it advisable for those with OAS to talk with their provider? You should talk to your physician if: - • Y our OAS symptoms are causing significant throat discomfort;
- Your OAS symptoms are getting progressively worse; - Your OAS symptoms are caused by cooked fruits and vegetables; **- Your OAS symptoms are caused nuts;
- You develop systemic reactions after eat** ing raw fruits or vegetables such as hives, vomiting or difficulty breathing.
"i get a little itchiness on the top of my mouth when i eat nuts" - If patient has an allergy to birch tree pollen who gives you the most urgent response?
- nut allergy. anaphylaxis in the near future
