Welcome! Check your audio connection to be sure your speakers are on and the volume is up.

Transcription

1 Welcome! Check your audio connection to be sure your speakers are on and the volume is up. An On-Demand recording of this webinar will be available at: 1 SNA CEU will be available upon completion of a quiz. The quiz link will be ed to you within 1 hour after the webinar concludes.

2 Today s Moderators Sherry Coleman Collins, MS, RDN, LD Registered Dietitian National Peanut Board Toni Vega Aiken Senior Manager of Professional Development School Nutrition Association

3 FOOD ALLERGY Discussing the Science Behind the Facts

4 Affiliation or Financial Disclosure Sherry Coleman Collins, MS, RDN, LD Consultant National Peanut Board S Shahzad Mustafa, MD FAACT - Chairman, Medical Advisory Board

5 Questions & Answers 75 minutes Q&A at the conclusion Type your questions into the Question box at any time during the webinar Questions will be addressed during the webinar and at the end as time allows

6 Earning CEUs Complete Evaluation and Quiz Print CEU at the end of the quiz. The link is provided at the end of this webinar and ed to you.

7 SNA CEUs & Professional Standards Key Area 1 (1000) Nutrition Key Topic: (1100) Menu Planning Subtopic (1160) Food Allergies

8 Handouts Locate the Handout panel on your control panel. Click on the name of the handout to download. PDF of today s slides Food Allergy Resources Handout Webinar Evaluation/Quiz Handout

9 LEARNING OBJECTIVES At the conclusion of today s webinar, participants should be able to: Explain the basics about food allergies, including signs and symptoms of a food allergy reaction and take steps to assist an allergic individual. Discuss the impact of food allergies on quality of life for those with this condition. Recommend and implement strategies to help improve the quality of life for those with food allergies.

10 Today s Speaker S Shahzad Mustafa, MD Allergist / Clinical Immunologist Rochester Regional Health Clinical Assistant Professor of Medicine, University of Rochester

11 FOOD ALLERGY Discussing the Science Behind the Facts

12 My Two Hats

13 James Daly - Author You cannot be distracted by the noise of misinformation.

14 Definition of a Food Allergy An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Boyce. JACI 2010; 126: Allergy Requires sensitization Validated diagnostic testing Reproducible reactions Dose independent Caused by an individual allergen Cannot block with pre-treatment Desensitization protocols Can lead to death Intolerance Can occur in absence of sensitization Minimal validated diagnostic testing Reactions can occur inconsistently Frequently dose dependent Can be caused by a class effect Validated pre-treatment regimens Desensitization not possible Typically very little mortality

15 Common Food Allergens Pediatrics Food % Cow s milk 2.5 Egg white 1.5 Peanut 1.0 Tree nuts 0.5 Wheat 0.4 Soy 0.4 Shellfish 0.1 Finned fish 0.1 Sesame 0.1* Adults Food % Peanut 0.6 Tree nuts 0.6 Shellfish 2.0 Finned fish 0.4 Sesame 0.1* Boyce. JACI 2010; 126: 1105.

16 Definition of Anaphylaxis Acute, potentially life-threatening systemic/multi-organ reaction that is immunologically mediated and occurs after the likely exposure to an allergen Clinical diagnosis Very little if any role for acute diagnostic testing Allergy/immunology referral recommended for long term management

17 Signs and Symptoms Common complaints NOT suggestive of an IgE mediated mechanism Isolated rhinitis Isolated cough/asthma Chronic abdominal discomfort Isolated GERD Chronic urticaria Fatigue Reactions occur inconsistently Reactions occur only with larger doses Ongoing mild to moderate atopic dermatitis

18 Time to Respiratory or Cardiac Arrest Pumphrey RS. Clin Esp All 2003; 30(8): 1144.

19 Management of Anaphylaxis Epinephrine is the 1 st line and only FDA approved therapy Antihistamines act as an adjunctive therapy mostly aimed at skin symptoms Systemic steroids decrease the risk of biphasic or protracted reactions

20 Mediators of Anaphylaxis Leukotrienes Prostaglandins Kinins Platelet activating factor Interleukins Tumor necrosis factor Histamine Benadryl (diphenhydramine)

21 Management of Anaphylaxis Epinephrine a 1 -adrenergic receptor a 2 -adrenergic receptor b 1 -adrenergic receptor b 2 -adrenergic receptor Vasoconstriction Peripheral vascular resistance Mucosal edema Insulin release Inotropy Chronotropy Bronchodilation Vasodilation Glycogenolysis Mediator release Simons. Curr Opin All Clin Immunol 2010; 10: 354.

22 Management of Anaphylaxis Epinephrine Antihistamines Simons. JACI 1998; 101: 33. Jones. Ann All Asth Immunol 2008; 100(5): 458.

23 Epinephrine Auto-Injectors

24 Poll Question Does your school maintain stock epinephrine to treat food allergy reactions?

25 Quality of Life with Food Allergy 70% reported significant effects on social events 60% reported significant effects on meal preparation 40% reported a significant increase in overall stress levels 34% reported an effect on school attendance 10% chose to home school their children Although other allergic conditions also have implications on quality of life, the addition of asthma and/or additional atopic conditions did not change these activity scores Bollinger. Annals All Asthma Imunol : 415., Springston. Ann All Asthma Immunol : 287

26 Mortality Associated with Food Allergy Umasunthar. Clin Exp All 2013; 43: 1333.

27 Impact on Parents Springston. Ann All Asthma Immunol : 287.

28 QOL with Peanut Allergy Versus Diabetes 20 children with peanut allergy, 20 children with diabetes Ages 7-12 Avery. Ped All Immunol 2003; 14:378.

29 Differences in QOL Self-reported allergy versus patients followed at a food allergy referral center Ward. JACI IP 2016; 4: 257.

30 Differences in QOL Ward. JACI IP 2016; 4: 257.

31 Differences in QOL Based on Food Ward. JACI IP 2016; 4: 257.

32 Goldilocks Principle Relaxed readiness optimal level of anxiety that facilitates adaptive coping and effective disease management while minimizing maladaptive hypervigilance and potentially dangerous risk taking behavior

33 Over-Diagnosis of Food Allergy Fleischer. J Peds 2011; 158(4): 578.

34 Diagnostic Tools Skin prick testing and in vitro immunoassays indicate the presence of IgE antibody Skin prick testing and in vitro immunoassays do NOT prove clinical reactivity Food allergy requires the presence of IgE antibody AND clinical reactivity Detailed Clinical History Skin Prick Test Immunoassay Oral Food Oral Challenge Food Challenge Upwards of 50-60% of individuals have presence of IgE in the absence of clinical reactivity Celik-Bilgli. Clin Exp All 2005; 35(3): 268.

35 Oral Food Challenges Performed to confirm or refute IgE mediated food allergy or to evaluate resolution of IgE mediated food allergy Total Challenges 701 Failed challenges 132 (18.8%) Reactions limited to skin symptoms 75 (10.7%) Reactions requiring epinephrine 12 (1.7%) Reactions requiring 2+ doses of epinephrine 1 (0.14%) Reactions requiring treatment in ED 1 (0.14%) Lieberman J. JACI 2011; 128(5); 1120.

36 Oral Food Challenges and QOL Franxman. JACI IP 2015; 3: 50.

37 Food Pollen Syndrome Presents with oropharyngeal itching and discomfort typically with fresh fruits and vegetables in individuals allergic to environmental allergens

38 Airborne Peanut Allergen Participants consumed peanuts to simulate various conditions Cafeteria setting Sporting event Commercial airliner Participants measured airborne protein via personal air monitors during the eating sessions with room ventilation turned off Perry. JACI 2004; 113(5): 973.

39 Rick of Airborne & Contact Exposure to Peanut Simonte. JACI 2003; 112(1): 180.

40 Poll Question What are the routes that can cause anaphylactic reactions to food?

41 Patient Views on Precautionary Labeling Hefle. JACI 2007; 120(1): 171.

42 Provider Views on Precautionary Labeling Turner. JACI IP 2016; 4: 165.

43 Provider Views on Precautionary Labeling Turner. JACI IP 2016; 4: 165.

44 Precautionary Labeling Percentage of Products with Detectable Allergen Hefle. JACI 2007; 120(1): 171.

45 Poll Question How confident do you feel reading labels with regard to food allergy management?

46 Food Allergy Guidelines Boyce. JACI 2010; 126(6): S1.

47 Special Considerations Cow s milk allergy Roughly 70% will tolerate baked milk products Alternatives include soy milk, coconut milk, almond milk, rice milk Cannot safely consume goat s milk Egg allergy Roughly 70% will tolerate baked egg products Safe to administer influenza and MMR vaccines Shellfish and finned fish allergy Safe to receive contrast for radiographic studies Systemic reactions with airborne exposure have been reported

48 Special Considerations (cont d) Soy allergy Safe to consume soy lecithin Peanut allergy Minimal if any risk with airborne exposure 95%+ will tolerate other legumes Nearly all will tolerate highly refined peanut oil Tree nut allergy Nearly all will tolerate coconut and shea nut No cross reactivity with seeds Reasonable to avoid certain tree nuts but consume others

49 Prevention of Peanut Allergy in the US Tojias. JACI 2017; 139: 29.

50 High Risk Infants Tojias. JACI 2017; 139: 29.

51 Summary Management of food allergies involves minimizing risk of allergen exposure while maintaining an acceptable quality of life Behaviors should ideally be based on scientific evidence Minimizing broad food elimination Risks associated with airborne and contact exposure Correct Interpretation of labeling Special considerations for individual foods Early introduction of peanut is likely to decrease prevalence of peanut allergy, especially in high risk infants

52 Questions?

53 Upcoming Webinars Next Week! Join Us For: Schools As Nutrition Hubs: The Business Savvy Strategy to Reduce Childhood Hunger Wednesday, March 22, 2017 View and Register for Upcoming Webinars: bit.ly/sna-webinars All Webinars begin at 2PM EST

54 Never miss an SNA webinar again! Every SNA Webinar is Recorded and Hosted in the SNA On-Demand Library! Over 35 webinars All Key Areas Meets professional standards training requirements On-Demand Webinars:

55 Thank you! All webinar evaluation/quiz links will begin with bit.ly/ and will be followed by the full date of when the webinar aired. Please TYPE the link EXACTLY as it is displayed below: BIT.LY/WWMARCH152017