Allergies from A to Z

It’s that time of the year again, the thing kids dread and parents love… the first day of school! Whether your child is in preschool or high school, if your kid has food allergies it’s always a struggle to figure out what to pack in their lunch and make sure they avoid eating, but ensure they get the essential nutrients they need to stay focused in school and have enough energy to go out for the sports. Now, allergies may be as common as Starbucks locations but it’s always better to over-prepare in these situations. The prevalence of food allergies in the world is actually astounding; 4-8% of children under the age of 2, 1-3% of 3-10 year olds, and 3-4% of adults are food allergic. And while 2/3 of children will lose their food allergies over time (most frequently egg, milk, soy and wheat), peanut, tree nut, fish and shellfish allergies tend to be life long. Food allergies are classified as Type I Hypersensitivity, and specific food allergies fall under two umbrellas: 1. Immune mediated (Gastrointestinal allergy) or 2. Non-immune mediated (Gastrointestinal intolerance). When you typically think of food allergies you think of peanuts, wheat or eggs, and these fall under the 1st umbrella (immune mediated). The most common acute symptoms are hives, flushing, itching, eczema or swelling, but immediate GI hypersensitivity symptoms such as nausea, abdominal pain, vomiting and cramping within 1-2 hours of ingestion or diarrhea within 2-6 hours of ingestion, also commonly occur. Most of these reactions occur within minutes to up to 4 hours after exposure. Milk and wheat are the two big guys that may compromise your nutritional adequacy and are on the forefront of young children growth concerns. Approximately 50% of young children with food allergies do not meet the recommended number of servings for milk and fruit, 75% do not meet the requirements for meat, grains or vegetables and intakes were low (less than 67% of the recommended daily allowance) for calcium, vitamin D, vitamin E and zinc. What I like to call the “G8 Allergens” are the eight most prevalent food allergies that cause 90% of all allergic reactions. G8 Allergens -        Milk -        Wheat -        Soy -        Peanut -        Egg -        Tree nuts -        Fish -        Shellfish Cows milk allergy (CMA) occurs in 3-5% of infants, and this should not be confused with lactose intolerance. CMA is a sensitivity to milk proteins such as casein or whey, while lactose intolerance is an intolerance related to an enzyme deficiency, not an actual food allergy. The good news is 85-90% of infants with CMA can tolerate soy, and even better news, 80% of infants outgrow this by the age of 3 or 4. Individuals with this allergy cannot tolerate lactaid (lactofree milk), goats milk, sheeps milk, pediasure or 1-2% milk. Growth and adequent intakes of essential nutrients are a serious concern for this population, especially in regards to calcium. The highest non-dairy sources of calcium are: sardines (3oz) with 325 mg, canned pink salmon (3oz) with 181 mg, collards and spinach (1/2 cup cook, separately) 150-180 mg, and calcium fortified juices with 100-300 mg. Wheat allergies are extremely serious because 4 serving of enriched or whole grains provides 50% of the recommended daily allowance for carbohydrates, iron, thiamin, riboflavin, niacin, vitamin B6, folate and manganese for individuals >1 year old. Carbohydrates are the main source of energy for our brain so it is imparative to receive carbohydrates from alternate grains such as rice, corn, oats, rye and barley. However, 20% of those with wehat allergy may be clinically reactive to another grain because of their protein composition. Eggs, soy and peanuts are less of a concern because they are not as nutritionally dense and therefore do not have as much of a nutritional impact. However, specifically with eggs, vaccinations should be on your radar. Influenza and yellow fever vaccines are typically not safe because they contain egg proteins. The most common reaction to eggs is atopic dermatitis and the egg proteins that usually cause this reactivity (ovalbumin, ovomucoid and ovotransferrin) are primarily found in the egg white, not the egg yolk. Peanut allergies, while not the most nutritionally severe, are among the most common and illicit the most severe reactions. However, 19% of kids with peanut allergies may actually eventually develop tolerance to the nut. From a dietician’s perspective, we want to counsel individuals with food sensitivites to effectively avoid the food yet ensure nutritional adequacy to maintain healthy growth rates. If you or your child suffers from food allergies, it is crucial to see a registered dietitian who will counsel you on how to safely and effectively change your diet. When you see your dietitian or physician, the first step is usually an elimination diet where you completely avoid the food allergy for 1-2 weeks, and possibly reintroduce each suspected food into your diet one at a time to pinpoint the allergen. Laboratory and clinical testing is also done in more severe cases in which a physician will test do a skin test for food specific IgE antibodies. However, the “gold standard” of food allergy testing is the double blind, placebo-controlled food challenge. Did you know that depending on your food allergy, you may have a heightened risk for other food allergies? Here is a chart of the most common risk related allergies.

 
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