ADVANCED DIPLOMA IN PRINCIPLES OF NUTRITION BY AMANDA BRODERICK BSc ANutR BSC HONS Sports Biomedicine and Nutrition Course Educators: Thomas Woods, William Eames @ShawPhotoTom BY AMANDA BRODERICK LESSON: 6
Special Diets Semester : Practical Lesson 6 Food Allergies and Intolerances Course Educator: Amanda Broderick Course Educator B.A. (Hons.) @ShawNutritionA amandabroderick@shawacademy.com
Practical Lesson 6 Learning Outcomes Peanut Allergy Soya Allergy Wheat Exclusion Egg Allergy Fish and Shellfish Allergy Fruit and Veg Allergy Food Labelling
Peanut and nut exclusion Most serious form of food allergy to emerge in recent years Sensitivity can be extreme Minute amounts of the allergen can trigger a rapid and severe IgE-mediated response Can cause acute oro-pharyngeal swelling and systemic circulatory effects which can result in asphyxiation and fatal anaphylaxis 4 in 5 children will go on to have nut allergy as an adult
Peanut and nut exclusion Symptoms; Skin reactions, such as hives, redness or swelling Itching or tingling in or around the mouth and throat Digestive problems, such as diarrhoea, stomach cramps, nausea or vomiting Tightening of the throat Shortness of breath or wheezing Runny nose Treatment: antihistamine or adrenaline
Management of peanut and nut allergy Treatment: complete avoidance! Peanut grows from the ground - often called groundnut Avoid its inhalation Avoid absorption through skin Complete avoidance of nuts is essential - usually allergic to more than one type of nut Risk of inadvertent exposure is high - important to carry and know how to administer adrenaline Under new EU law both refined and unrefined peanut oil have to be declared on food labels Eating out and takeaways-sometimes peanuts used as cheap alternative to ground almond Peanut butter is secret ingredient in some dishes Airborne contamination: some people can react to airborne particles on aeroplanes Foreign travel: not all foods are prepared in the same way in different countries so important not to presume something is nut free
Soya Allergy Soya bean: legume and its derivatives used widely e.g. binder in the form of flour or a meat extender or meat replacement Common in children known to have a cow s milk allergy As much as 60% of manufactured foods contain soya: Soya beans Soya flour Soya protein/gum/starch Texturised (or hydrolysed) vegetable protein Soya sauces Soya flavourings Soya lecithin Level of tolerance needs to be established on an individual basis under medical supervision
Soya Allergy Symptoms associated with soya allergy include anaphylaxis, eczema, rhinitis, conjunctivitis and bronchospasm (after inhalation of soya bean dust), angioedema, abdominal pain, laryngeal oedema, respiratory complaints and urticarial, infantile colitis and food protein-enterocolitis syndrome
Guidance for Soya Avoidance Common sources: Vegetarian foods Meat and fish products Ready meals Oriental foods and sauces Bread Cakes and biscuits Desserts Snack foods and confectionery Many hidden sources- important to read food labels carefully Terms that indicate the presence of soya Soya protein isolate Soya shortening Soya protein Soya albumin Soya bean Soya flavouring Soya flour Soya gum Soya lecithin (E322) Soya milk Soya nuts Soya oil Soya starch
Wheat Allergy May provoke either IgE-mediated severed allergic reaction or non-ige mediated chronic diffuse gastrointestinal symptoms IgE-mediated wheat allergy: may require total wheat exclusion Not all reactions to wheat are true allergies Partial exclusion may be sufficient in some non-igemediated food allergy or non-allergic forms of wheat hypersensitivity The threshold of sensitivity varies and some people obtain symptom relief by simply reducing wheat intake
Wheat Allergy The most common reactions are: Immediate type allergy to wheat Delayed allergy reactions to wheat Delayed type allergy to gluten, known as Coeliac Disease Intolerance to wheat
Allergy to Wheat - 4 types 1) Immediate Type Caused by an IgE reaction to a protein in wheat grain Most common in infants Usually resolve within first few years of life Symptoms: Rhinitis, asthma, urticarial, angioedema, conjunctivitis Loose faeces, abdominal pain, worsening of eczema 2) Delayed allergic reaction significant worsening of symptoms usually within 24-48 hours In all 3, wheat should be eliminated from the diet 3) Coeliac disease lifelong intolerance to gliadin (part of gluten protein in grains) cause an immune reaction resulting in damage to the small intestine The antibodies which are involved are a different class to the IgE antibody that causes classical food allergy
Wheat Intolerance 4) Wheat intolerance is different - poorly defined set of symptoms Varies considerably in individuals Symptoms: abdominal discomfort, nausea, tiredness, bloating and altered bowel habits NOT an immune reaction - not life threatening like wheat allergy People with wheat intolerance will still experience adverse symptoms from gluten free products, as the remaining part of the wheat will be affecting them may, or may not, be able to eat rye, barley and oats may be able to reintroduce wheat back into the diet after a period of elimination Sensitivity to wheat (and gluten) can also produce symptoms in some individuals which means they have to avoid these substances
Sources of Wheat in the Diet Breads and baked foods Cereals Flour and pasta Meat and fish Vegetable products Sauces and condiments Beverages Confectionery Medication Durum wheat, spelt (triticum spelta), kamut (triticum poloncium) Couscous Bran, wheat bran, wheat germ, wheat gluten Farina Rusk Semolina, durum wheat semolina Flour, wholewheat flour, wheat flour, wheat starch Starch, modified starch, hydrolised starch, food starch, edible starch Vegetable starch, vegetable gum, vegetable protein Cereal filler, cereal binder, cereal protein. This is not an extensive list of sources - it is a guide
Egg Allergy Common in infancy Can cause acute IgE-mediated reactions In most cases egg allergy will resolve by 5 years Egg and egg derivatives include: Fresh egg Dried egg Egg yolk Egg white (or egg albumen) Egg lecithin. Lecithin used in food manufacture is more likely to be derived from soya than egg, but if this is not specified, the origin needs to be checked with the manufacturer. Most patients with an egg allergy will be able to tolerate egg lecithin, but reactions in the past have been reported.
Egg Allergy Eggs are also a major component of foods such as: Meringue Quiche-type flans Egg custards Scotch egg Mayonnaise and dips Yorkshire pudding, batters and pancakes Cakes Quorn products (these contain rehydrated egg white) However egg can also be a less obvious ingredient of foods such as pasta, biscuits, ice-cream, egg glazes, sweets and desserts. Since acute reactions to egg can result from ingestion of trace amounts, it is vital that all food labels are carefully scrutinised for its presence Since 70% of egg proteins are denatured with heat, children are often able to tolerate egg cooked in a food product e.g. sponge cake
Fish and Shellfish Exclusion Fish and shellfish can provoke severe IgE-mediated allergic or pharmacologically mediated reactions It is therefore important to distinguish between those induced by fish allergy and those induced by non-allergic reactions such as histamine poisoning Adverse reactions to fish/shellfish are common a frequent cause of several types of symptoms, which may begin with oral allergy syndrome and end in anaphylaxis These reactions are frequently related to asthmatic symptoms
Fish and Shellfish Exclusion Shellfish (crustaceans) include prawns/ shrimps, crayfish, crabs and lobsters Molluscs, on the other hand, include bivalves (clams, oysters, mussels and scallops), snails, octopus, squid, and cuttlefish High level of cross-reactivity is seen between shellfish and mollusc Individuals with a fish allergy are often allergic to more than one type of fish or shellfish, but an IgEmediated allergy to one type of fish does not necessarily indicate that all fish must be avoided.
Fish and Shellfish Exclusion Less obvious sources of fish/shellfish can include: Ingredients such as fish stock/puree/bouillon Worcester sauce (which contains anchovies) Food served at buffets and banquets where the contents of soups, hors d oevres, vol-auvents, sauces etc may not be present Oriental (especially Thai) dishes which often contain seafood as an ingredient or fish stock or sauce. Fish oil supplements Health food preparations such as green lipped mussel extract (particularly cheaper, less purified products) Aspic (can be derived from fish bones) Caviar
Allergy to Fruit and Veg Relatively uncommon Symptoms develop within minutes of exposure but occasionally can take 1-2 hours Most common: Apple, pear, cherry, peach, plum Cucumber, melon, watermelon, zucchini, pumpkin Kiwi fruit- may cause more severe reaction than other fruits Fruit allergy usually due to proteins- prolifins More common in older children and young adults Legumes: peanut, soybean, fresh or dried bean seeds, pea, green beans and lentils Most people allergic to one will not be allergic to another type
Histamines Chemical which occurs naturally in certain foods Also a chemical released in the body as part of an allergic reactioncausing typical itching, sneezing, wheezing and swelling allergy symptoms Enzyme (diamine oxidase) breaks down histamines from food Some people have low levels of this enzyme When they eat too much histamine containing food they develop symptoms such as headaches, rashes, itching, diarrhoea, vomiting, abdominal pain: histamine intolerance Foods that are particularly high in histamine and other vasoactive amines include: Champagne, wine, beer, cider and other fermented drinks and spirits Sauerkraut and other pickled foods Vinegar and foods containing it such as dressings, pickles, mayonnaise, ketchup, mustard Tofu and soya sauce Parmesan cheese and other cheeses Sausages and other processed meats (ham, salami, gammon, bacon) Mushrooms and quorn Tinned and smoked fish (tuna, salmon, herring) and crustaceans Prepared salads Tinned vegetables Dried fruit, seeds, nuts Yeast extract, yeast Chocolate, cocoa, cola
Foods Sources of Histamine Bananas Tomatoes Strawberries Nuts Peanuts Shellfish Egg white Chocolate Pumpkin Spinach Aubergines Avocado Papayas Kiwi Pineapple Mango Raspberry Tangerines Grapefruits Red prunes Pea spices
Food Labelling Some components in a form that is not always obvious to the consumer e.g. caseinates or lacto globulin are milk derivatives Not always easy to identify allergen in food Food origin of other ingredients may not be declared e.g. additive lecithin could be derived from soya or egg EC directive 2003 ensures the following are on labels: Cereals containing gluten Crustaceans Eggs Peanuts Soya beans Milk Nuts Celery Mustard Sesame seeds Sulphur dioxide and sulphites at concentrations>10mg/kg or 10mg/l expressed as SO2
In Conclusion 90% of all food allergic responses are related to: 1. Milk 2. Eggs 3. Peanuts 4. Tree nuts (e.g. walnuts, almonds, cashews, pistachios, pecans) 5. Wheat 6. Soy 7. Fish 8. Shellfish Allergen diagnosis tests should always be done under medical supervision
Next Steps Try attend all of the sessions live and see your knowledge grow Lesson 7 will cover Treating Nutritional Deficiencies Recordings are uploaded within 24 hours of the completion of each live session Further reading links are available if you wish to learn more
To expand upon the subjects covered in todays lesson: Further Learning Basic nutrition- Diploma in Nutrition Weight loss- Ultimate weight Loss Programme
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Further Reading 1) Manual of Dietetic Practice, 4 th edition, edited by Briony Thomas and Jacki Bishop 2) http://www.ncbi.nlm.nih.gov/pubmed/21236480 3) http://www.foodallergy.org/document.doc?id=194 4) http://www.who.int/mediacentre/factsheets/fs297/en/ 5) http://www.cancerresearchuk.org/cancer-info/cancerstats/world/cancer-worldwidethe-global-picture