FOOD ALLERGIES. Kendra Manwill

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1 FOOD ALLERGIES Kendra Manwill

2 ALLERGY VS INTOLERANCE Intolerance Lack a digestive enzyme Reactions are not typically life threatening Can cause similar symptoms to food allergies Allergy Abnormal immune response The protein is usually the allergen No cure Strict avoidance Hard to diagnose

3 Milk Eggs Wheat Nuts (tree) Soy Peanut Fish Shellfish TOP 8 ALLERGENS

4 COMMON ALLERGIC REACTIONS Skin Reactions Swelling of lips, tongue, face Itchy eyes Hives Rash (eczema) Respiratory Tract Reactions Swelling, itching, and/or tightness in throat Shortness of breath Dry/raspy cough Runny nose Wheezing (asthma) Digestive Tract Reactions Abdominal cramps Nausea Vomiting Diarrhea

5 LABEL READING Always read labels Formulations can change without warning Don t rely on safe lists Allergens can be in non-food items Soaps, shampoos, skin products, medications, pet foods

6 MILK

7 MILK Milk allergy Involves immune system Can be fatal Milk intolerance Missing enzyme lactase Cannot digest milk Not life-threatening, just causes discomfort

8 MILK: FOOD Avoid Butter Casein Cheese Pudding Sour Cream Whey Be Wary Of Artificial butter flavor Caramel Nougat Meat (check for casein as a binder) OK Calcium lactate Cocoa butter Cream of tartar Lactic acid Sodium lactate

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10 EGG

11 EGG Second most common allergy The whites of the egg contain the allergenic protein Be wary of vaccines Influenza

12 EGGS: FOOD Avoid Albumen Eggnog Mayonnaise Meringue Ovalbumin Eggs from duck, turkey, goose, quail, etc. Be Wary Of Baked goods Egg substitutes Lecithin Macaroni Marzipan Marshmallows Salted pretzels (egg wash) Coffee foam top

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14 WHEAT

15 WHEAT Wheat Allergy Overreaction of immune system to specific food protein Can often tolerate other grains Potentially fatal Gluten Intolerance/Celiac Disease Autoimmune disease Affects small intestine Abnormal immune reaction to gluten specifically Malnutrition and intestinal damage Avoid gluten: wheat, rye, barley, sometimes oats

16 WHEAT Most common in children Often outgrown by age 3 Alternatives: Amaranth Barley Corn Oat Quinoa Rice Rye Tapioca

17 WHEAT: FOOD Avoid Bulger Couscous Durum Farina Kamut Semolina Spelt Wheat grass Whole wheat berries Be Wary Of Glucose syrup Soy sauce Starch Play dough Potato chips Batter-fried foods Candy Imitation crabmeat

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19 TREE NUTS

20 TREE NUTS Lifelong Tree nuts include: Walnut Almond Hazelnut Cashew Pistachio Brazil nuts Does not include: Peanuts (legume)

21 TREE NUTS: FOOD Avoid Almond Artificial nuts Beechnut Butternut Coconut Macadamia nut Nut meal Pesto Shea Nut Be Wary Of Natural nut extract Nut oils Walnut hull extract Cereals Marinades Nut flavorings

22 SOY

23 SOY Most children outgrow allergy by 10 Mild reactions Increased chance of allergy to other legumes Peanuts, beans, peas, lentils Soy lecithin does not have soy, most people are ok Highly refined soybean oil is ok

24 SOY: FOOD Avoid: Edamame Miso Soy Soybean Soy sauce Textured vegetable protein Tofu Be Wary Of: Asian cuisine Vegetable gum/starch Cereals High protein energy bars Infant formulas Processed meats Canned broths and soups

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26 PEANUT

27 PEANUT Lifelong Siblings are more likely to have an allergy More likely to have a legume allergy Typically avoid tree nuts- cross contamination Trace amounts can cause a reaction Highly refined peanut oil is ok

28 PEANUT: FOOD Avoid: Artificial nuts Beer nuts Goobers Nut meat Peanut butter Mixed nuts Arachis oil (peanut oil) Be Wary Of: Baked goods Chili Egg rolls Marzipan Specialty pizzas Meat substitutes Glazes and marinades African, Asian, Mexican restaurants

29 FISH

30 FISH Lifelong ~40% develop as an adult Most common: Salmon Tuna Halibut Does not mean shellfish allergy Be careful in cooking areas- fish protein can be airborne during steaming

31 FISH: FOOD Avoid: Anchovies Fish sticks Mahi Mahi Pollock Snapper Tilapia Tuna Be Wary Of: Caesar salad/ dressing Worcestershire sauce Imitation fish (surimi) Meatloaf Barbecue sauce Chinese, African, Indonesian, Thai, Vietnamese restaurants

32 SHELLFISH

33 SHELLFISH Lifelong ~60% develop as an adult Most common: Shrimp Crab Lobster Does not mean finned fish allergy Two kinds: Crustacean (more severe) Mollusks (may not be fully disclosed on labels)

34 SHELLFISH: FOOD Avoid: Barnacle Crab Crawfish Krill Abalone* Octopus* Sea cucumber* Scallops* Be Wary Of: Cuttlefish ink Glucosamine Fish stock Seafood flavoring Surimi Asian restaurants *Doctor may suggest you avoid these

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36 CROSS CONTAMINATION Be very careful in food preparation Do not mix: Serving utensils Knives Cutting boards Skillets Scoops Plates Scraping food off of a plate is not adequate

37 LESSON PLAN Title Managing Food Allergies Target Audience_BYU Staff and Faculty Terminal Objective By the end of the lesson, learners will be able to identify the top 8 allergens, list some common ingredients to stay away from for each allergen, and explain why cross-contamination is a hazard. Name Kendra Manwill Method Example/non example, illustrated instruction_ Terminal Concept Food allergies can cause serious reactions, but avoidance of anything tainted by the allergen can allow the individual to live a normal life. Domain Cognitive Taxonomic Level_Application_ References Foodallergy.org NCM Krause ch 29 Complete Food and Nutrition Guide ch 21 Preparation Gather food nutrition labels demonstrating allergens Print copies of foodallergy.org reading labels handout Print one copy of each of NCM tips for allergies. If someone wants more information, they can have one. Create powerpoint Pre-assessment Does anyone know what the top food allergies are? Introduction Introduce myself Today we are going to talk about the basics of food allergies, and what the most common food allergies are. 1 min

38 Supporting Objectives Content Outline Time Learning Experience (Activity Outline) Learners will be able to explain the difference between allergy and intolerance Difference between allergy and intolerance Intolerance 4 min Show ppt slide 2 Learners will be able to identify the top 8 allergens Allergy Have different causes For metabolic reasons, people may not be able to digest a component of certain foods like lactose because a digestive enzyme is deficient. Some naturally occurring substances may cause reactions, but these aren t life threatening. Food intolerances can lead to similar symptoms as food allergies (nausea, diarrhea, abdominal cramps). Allergy is an abnormal immunological response to a harmless food protein. Allergen sets off a chain of immune system reactions No pharmaceutical intervention available to prevent reactions. Strict avoidance is the only way. Allergies are hard to diagnose, DO NOT self-diagnose Estimated 12 million Americans have food allergies, and it is very common in the first 3 years of life. Up to 90% of kids grow out of it Top 8 allergens: Milk Eggs 2 min Show ppt slide 3

39 Wheat Nuts (tree) Soy (legume) Peanut (legume) Fish Shellfish All of these are required to be listed as allergens if they are in a food. Mention common allergic reactions. Learners will be able to recognize common symptoms of allergies Mention symptoms of allergies Anaphylaxis: severe, potentially fatal allergic reaction. It can cause skin symptoms/swollen lips, difficulty breathing, reduced blood pressure, GI symptoms Carry an auto-injector like an epi-pen 2 min Show ppt slide 4 Explain how to look at labels, and understand the words they use 2 min Show ppt slide 5 Learners will be able to identify where to find the allergen list and the ingredient list Learners will be able to identify the difference between milk allergy and lactose intolerance. Learners will be able to identify Milk allergy Milk allergy is most common Milk allergy and lactose intolerance are different Milk allergy: involves immune system, can be fatal Lactose intolerance: missing an enzyme lactase, cannot digest lactose. Not life-threatening, just 4 min Show ppt slide 6, then 7

40 common ingredients that are unsafe for those with milk allergy. discomfort. Mention food with and without Show ppt slide 8 Show ppt slide 9 Learners will be able to identify common ingredients that are unsafe for those with egg allergy. Egg allergy Egg allergy is second most common Some vaccines contain egg protein, including the influenza vaccine Go over foods Allergy is to the protein, so some people can have cooked eggs 4 min Show ppt slide 10, then 11 Show ppt slide 12 Show ppt slide 13 Learners will be able to identify common ingredients that are unsafe for those with wheat allergy. Wheat allergy Wheat: allergy is to protein in wheat, can often tolerate other grains Celiac: autoimmune disease, the protein gluten isn t tolerated. Gluten intolerance is NOT wheat allergy Gluten is found in wheat, rye, barley, oats sometimes Wheat allergy is the most common allergy in children Baking is hard, try alternatives: amaranth, barley, corn, oat, quinoa, rice, rye, tapioca. A combination is often best. Go over foods 4 min Show ppt slide 14, then 15 Show ppt slide 16 Show ppt slide 17 Show ppt slide 18

41 Learners will be able to identify common ingredients that are unsafe for those with a tree nut allergy. Learners will be able to identify common ingredients that are unsafe for those with a soy allergy. Learners will be able to identify common ingredients that are unsafe for those with a peanut allergy. Tree nut allergy Tends to be lifelong Includes: walnut, almond, hazelnut, cashew, pistachio, brazil nuts Often is processed in the same plant as peanuts Does not include: peanut (legume), or sunflower seeds (seed) Go over foods Soy allergy Majority of children with soy allergy outgrow the allergy by age of 10 Reactions are typically mild People with a soy allergy are not necessarily allergic to other legumes, but you have a greater chance (peanut, beans, peas, lentils) Most people with a soy allergy can safely eat soy lecithin and soy oil. Highly refined soybean oil is ok Go over foods Peanut allergy Tends to be lifelong Siblings are more likely to have an allergy Greater chance of legume allergy 4 min 4 min 4 min Show ppt slide 19, then 20 Show ppt slide 21 Show ppt slide 22, then 23 Show ppt slide 24 Show ppt slide 25 Show ppt slide 26, then 27

42 Learners will be able to identify common ingredients that are unsafe for those with a fish allergy. Learners will be able to identify common ingredients that are unsafe for those with a shellfish allergy. (beans, peas, lentils, soybeans) Usually have to avoid tree nuts due to cross-contamination Trace amounts of peanuts may cause a reaction Go over foods Fish allergy Typically lifelong ~40% have first reaction as an adult Most common: salmon, tuna, halibut. More than half are allergic to more than one type of fish. Does not mean you are allergic to shellfish. Fish protein can become airborne in steam released during cooking. Go over foods. Shellfish allergy Typically lifelong ~60% have first reaction as an adult Most common: Shrimp, crab, lobster Does not mean you are allergic to finned fish Two kinds: crustacean (shrimp, crab, lobster) and mollusks (clams, mussels, oysters, scallops). 4 min 4 min Show ppt slide 28 Show ppt slide 29, then 30 Show ppt slide 31 Show ppt slide 32, then 33 Show ppt slide 34

43 Learners will understand the dangers of cross contamination Crustacean reaction tends to be more severe. May only be allergic to one kind, but recommend avoiding all. Go over foods 2 min Show ppt slide 35 Show ppt slide 36 Discuss cross contamination Be very careful if preparing food. Make sure the following are only used for one food item at a time: serving utensils, knives, cutting boards, skillets, scoops, plates, etc Just scraping the allergenic food off a plate is not sufficient. Particles are still present. Assessment (evaluation) Can anyone list the top 8 food allergies? Did anything we learned today surprise you? Do you have any questions? Closure There are many people with food allergies, it helps to be aware of what the most common allergies entail. Be very careful to avoid cross contamination, because even though you may not be serving someone the allergen directly you may transfer it indirectly.

44 How to Read a Label for a Milk-Free Diet All FDA-regulated manufactured food products that contain milk as an ingredient are required by U.S. law to list the word milk on the product label. Avoid foods that contain milk or any of these ingredients: butter, butter fat, butter oil, butter acid, butter ester(s) buttermilk casein casein hydrolysate caseinates (in all forms) cheese cottage cheese cream curds custard diacetyl ghee half-and-half lactalbumin, lactalbumin phosphate lactoferrin lactose lactulose milk (in all forms, including condensed, derivative, dry, evaporated, goat s milk and milk from other animals, lowfat, malted, milkfat, nonfat, powder, protein, skimmed, solids, whole) milk protein hydrolysate pudding Recaldent rennet casein sour cream, sour cream solids sour milk solids tagatose whey (in all forms) whey protein hydrolysate yogurt Milk is sometimes found in the following: artificial butter flavor baked goods caramel candies chocolate lactic acid starter culture and other bacterial cultures luncheon meat, hot dogs, sausages margarine nisin nondairy products nougat Food Allergy Research & Education (FARE) 7925 Jones Branch Drive, Suite 1100 McLean, VA info@foodallergy.org How to Read a Label for a Soy-Free Diet All FDA-regulated manufactured food products that contain soy as an ingredient are required by U.S. law to list the word soy on the product label. Avoid foods that contain soy or any of these ingredients: edamame miso natto shoyu soy (soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt) soya soybean (curd, granules) soy protein (concentrate, hydrolyzed, isolate) soy sauce tamari tempeh textured vegetable protein (TVP) tofu Soy is sometimes found in the following: Asian cuisine vegetable broth vegetable gum vegetable starch Keep the following in mind: The FDA exempts highly refined soybean oil from being labeled as an allergen. Studies show most allergic individuals can safely eat soy oil that has been highly refined (not cold pressed, expeller pressed, or extruded soybean oil). Most individuals allergic to soy can safely eat soy lecithin. Follow your doctor s advice regarding these ingredients. How to Read a Label for a Peanut-Free Diet All FDA-regulated manufactured food products that contain peanut as an ingredient are required by U.S. law to list the word peanut on the product label. Avoid foods that contain peanuts or any of these ingredients: artificial nuts beer nuts cold pressed, expeller pressed, or extruded peanut oil goobers ground nuts mixed nuts monkey nuts nut pieces nut meat peanut butter peanut flour peanut protein hydrolysate Peanut is sometimes found in the following: African, Asian (especially Chinese, Indian, Indonesian, Thai, and Vietnamese), and Mexican dishes baked goods (e.g., pastries, cookies) candy (including chocolate candy) chili Mandelonas are peanuts soaked in almond flavoring. The FDA exempts highly refined peanut oil from being labeled as an allergen. Studies show that most allergic individuals can safely eat peanut oil that has been highly refined (not cold pressed, expeller pressed, or extruded peanut oil). Follow your doctor s advice. egg rolls enchilada sauce marzipan mole sauce nougat Keep the following in mind: A study showed that unlike other legumes, there is a strong possibility of cross-reaction between peanuts and lupine. Arachis oil is peanut oil. Many experts advise patients allergic to peanuts to avoid tree nuts as well. Sunflower seeds are often produced on equipment shared with peanuts Food Allergy Research & Education (FARE)

45 How to Read a Label for a Wheat-Free Diet All FDA-regulated manufactured food products that contain wheat as an ingredient are required by U.S. law to list the word wheat on the product label. The law defines any species in the genus Triticum as wheat. Avoid foods that contain wheat or any of these ingredients: bread crumbs bulgur cereal extract club wheat couscous cracker meal durum einkorn emmer farina flour (all purpose, bread, cake, durum, enriched, graham, high gluten, high glucose syrup soy sauce protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat) hydrolyzed wheat protein Kamut matzoh, matzoh meal (also spelled as matzo, matzah, or matza) pasta seitan semolina spelt Wheat is sometimes found in the following: starch (gelatinized starch, modified starch, modified food starch, vegetable starch) sprouted wheat triticale vital wheat gluten wheat (bran, durum, germ, gluten, grass, malt, sprouts, starch) wheat bran hydrolysate wheat germ oil wheat grass wheat protein isolate whole wheat berries surimi How to Read a Label for a Egg-Free Diet All FDA-regulated manufactured food products that contain egg as an ingredient are required by U.S. law to list the word egg on the product label. Avoid foods that contain eggs or any of these ingredients: albumin (also spelled albumen) egg (dried, powdered, solids, white, yolk) eggnog lysozyme mayonnaise meringue (meringue powder) ovalbumin surimi Egg is sometimes found in the following: baked goods egg substitutes lecithin macaroni marzipan marshmallows nougat pasta Keep the following in mind: Individuals with egg allergy should also avoid eggs from duck, turkey, goose, quail, etc., as these are known to be cross-reactive with chicken egg. How to Read a Label for a Shellfish-Free Diet All FDA-regulated manufactured food products that contain a crustacean shellfish as an ingredient are required by U.S. law to list the specific crustacean shellfish on the product label. Avoid foods that contain shellfish or any of these ingredients: barnacle crab crawfish (crawdad, crayfish, ecrevisse) krill lobster (langouste, langoustine, Moreton bay bugs, scampi, tomalley) prawns shrimp (crevette, scampi) Mollusks are not considered major allergens under food labeling laws and may not be fully disclosed on a product label. Your doctor may advise you to avoid mollusks or these ingredients: abalone clams (cherrystone, geoduck, littleneck, pismo, quahog) cockle cuttlefish limpet (lapas, opihi) mussels octopus oysters periwinkle scallops sea cucumber sea urchin snails (escargot) squid (calamari) whelk (Turban shell) Shellfish is sometimes found in the following: bouillabaisse cuttlefish ink fish stock glucosamine seafood flavoring (e.g., crab or clam extract) surimi Keep the following in mind: Any food served in a seafood restaurant may contain shellfish protein due to cross-contact. For some individuals, a reaction may occur from inhaling cooking vapors or from handling fish or shellfish. How to Read a Label for a Tree Nut-Free Diet All FDA-regulated manufactured food products that contain a tree nut as an ingredient are required by U.S. law to list the specific tree nut on the product label. Avoid foods that contain nuts or any of these ingredients: almond artificial nuts beechnut Brazil nut butternut cashew chestnut chinquapin nut coconut filbert/hazelnut gianduja (a chocolate-nut mixture) ginkgo nut hickory nut litchi/lichee/lychee nut macadamia nut marzipan/almond paste Nangai nut natural nut extract (e.g., almond, walnut) nut butters (e.g., cashew butter) nut meal nut meat nut paste (e.g., almond paste) nut pieces pecan pesto pili nut pine nut (also referred to as Indian, pignoli, pigñolia, pignon, piñon, and pinyon nut) pistachio praline shea nut walnut Tree nuts are sometimes found in the following: black walnut hull extract (flavoring) natural nut extract nut distillates/alcoholic extracts nut oils (e.g., walnut oil, almond oil) walnut hull extract (flavoring) Keep the following in mind: Mortadella may contain pistachios. There is no evidence that coconut oil and shea nut oil/butter are allergenic. Many experts advise patients allergic to tree nuts to avoid peanuts as well. Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of people with tree nut allergy. However, in October of 2006, the FDA began identifying coconut as a tree nut. Medical literature documents a small number of allergic reactions to coconut; most occurred in people who were not allergic to other tree nuts. Ask your doctor if you need to avoid coconut. Talk to your doctor if you find other nuts not listed here Food Allergy Research & Education (FARE)