Food Allergies and Reading a Food Label
avocado banana chestnut kiwi
30-50% of people with a latex allergy have sensitivity to one or more fruits including:
medications
35% of anaphylaxis is caused by _
peanut
Arachis hypogaea
oat
Avena sativa
coconut
Cocos nucifera
no, only foods the FDA considered major food allergens
Do all foods need to be declared on food labels?
-non top 8 food allergens -drugs (prescription and OTC) -cosmetics -personel care products
FALCPA labeling requirement do not apply for:
-within the ingredient list -immediately after the ingredient list in a "contains" statement
FALCPA-regulated allergens (top 8) must be labeled in one of two ways:
food allergen labeling and consumer protection act (FALCPA) of 2004
FDA enforces the regulations requiring companies to list ingredients on packaged food and beverages; also provides guidance to the food industry, consumers, and other stakeholders on ways to assess and manage allergen hazards in foods
walnut
Juglans
tomato
Lycopersicon esculentum
bitter almond
Prunus amygdalus amara
sweet almond
Prunus amygdalus dulcis
apricot
Prunus armeniaca
sesame
Sesamum indicum
true
T/F: a person can develop an allergy to previously safe foods at any age
false
T/F: an advisory/precautionary statement is required on foods that contain allergens; "manufactures on equipment that processes peanut and tree nuts"
true
T/F: any food serves in a seafood restaurant may contain shellfish protein due to cross-contact
false
T/F: food allergens in medications are screened for and flag on most interaction data bases
false
T/F: food allergies are decreasing in prevalence
true
T/F: highly refined derivatives are not considered allergens by the FDA
true
T/F: immediate interventions like brushing teeth or chewing gum is not effective in removing allergens
false
T/F: milk protein allergies and lactose intolerance are the same thing
true
T/F: people allergic to eggs should still get the flu shot
false
T/F: sanitizing gels will remove an allergen
true
T/F: studies show that most individuals who are allergic to soy can safely consume highly refined soy oil
wheat
Triticum
corn
Zea mays
adverse drug reactions
_ affect up to 10% of the US population; affects 20% of hospitalized patients
sunflower seeds
_ are often produced on equipment shared with peanuts
daily values
_ are the references amounts that a person should consume or not exceed each day
coconut
_ has typically not been restricted in the diets of people with a tree nut allergy, however the FDA has started to refer to it as a tree nut
contains statement
_ is NOT mandatory, allergen can be listed only in the ingredient list
hypersensitivity
_ reactions account for 10% of all adverse drug reactions
DPI (dry powder inhalers)
_ routinely contain lactose
% daily value
_ shows how much nutrients are in a serving of the food
allergen processing
_ warning statements are NOT required by the FDA, but are included on some labels
5% or less
_% or less is considered to be a low percent daily value
20% or more
_% or more is considered to be a high percent daily value
SPINKS
a 2017 study shows a gene called _ is associated with IgE-mediated food allergy in infants
contamination
a food allergen contaminates another food that is naturally free from the allergen
3 minutes
a food allergy reaction sends a person to the ER every _ minutes in the US
never
a food, medication, over the counter medication, or personal care product should _ be labeled as safe for ANY food allergy patient
cornstarch
a main source of airborne inhalable latex allergens is _ particles that are used in powdered natural rubber latex gloves
excipient
a substance formulated alongside the active ingredient; bulking agents, fillers, diluents ; work to facilitate drug absorption, reducing viscosity, or enhancing solubility
15%
adulthood diagnosis for at least _% of patients with food allergies
direct cross contact
allergen was directly applied and then removed
indirect cross contact
allergen was not directly applied
Yes
can excipients cause an allergic reaction?
yes
can pharmaceutically equivalent products have different excipients?
2.5x
children in households with lower income incurred _ times the ER and hospitalization costs than higher income children
asthma eczema/skin allergy
concurrent comorbidities are common with food allergies, including:
yes
do major food allergens contained in dyes, spices, flavorings, additives, and processing aids have to be listed on labels?
FALCPA does not apply for foods placed in a container or wrapper for a customer's individual order
do major food allergens have to be listed in cases where cross-contamination could be evident (restaurants/bakeries)?
foods
do not use products that contain _ on damaged, eczematic skins due to risk of sensitization
yes
do the specific types of nuts, fish, or shellfish have to be indicated on the label?
no, the contains statement is one of two options food manufacturers have for listing the presence of major food allergens
does a food label have to include the "contains" statement at the end with the major allergen bolded?
no
does the label have to declare "traces" of peanut, milk, or other allergens that have come about through processing?
dual exposure therapy
exposure through skin promotes sensitization but through the GI-tract promotes tolerance
labeler (manufacturer)
fist set of numbers in an NDC
inactive ingredients
food allergens are often found in the _ section for many medications
8-11%
food allergies affect _% of children in the US
immune system
food allergies are an issue of the _ system
-prescription medications -OTCs -personal care products
food allergies are not just found in foods, but can also be found in:
digestive system
food intolerances are an issue of the _ system
25%
greater than _% of adults state that all their food allergies began during adulthood
call the maufacturer
how can consumers find out about other allergens that are not FLACPA and listed on products?
1 in 13
how many children under the age of 18 are affected by food allergies in the US?
32 million
how many people in the US have food allergies?
25 billion
how much is spent annually on pediatric food allergies
not necessarily; manufacturers are not required to warn you if the product is processed on lines or in a facility with any other food
if a product does not have precautionary warnings, does this mean the product is safe to consume?
adulteration
in a pharmacy setting, contamination is referred to as _
total sugar
includes naturally present sugar as well as added sugar
cows milk
individuals who are allergic to _ are often advised to avoid milk from all domestic animals; may cause a reaction in those with this allergy
no
is sesame included in FLACPA?
only crustacean shellfish (shrimp, crab, lobster); molluscan shellfish do not have to be indicated (clams, mussels, oysters)
is shellfish considered a major allergen?
milk
lac, bos taurus
macadamia/bush nut
macadamia ternifolia
peanuts
many experts advise people allergic to _ to avoid tree nuts as well
Food Allergy Safety,Treatment, Education, and Research Act (FASTER Act)
marked labeling for the sesame ingredient as an allergen mandatory and to recognize sesame as the ninth major food allergen in the US
specifically ask about food allergies when screening patients
medical staff in general, but especially pharmacy staff MUST _ -it is theist line of defense before the patient receives medication and therapy must be individualized based on allergens
milk protein allergens
most inhalers contain what food allergen?
inactive ingredients
most of the time food allergens can only be found by examining the list of _
50%
nearly _% of adults report the development of at least one food allergy after 18 years of age
allergic symptoms
new 2017 study concluded that hand eczema and food allergy diagnoses were more common in occupational kitchen workers with more severe hand eczema being more likely to suffer _
excipients
not regulated like food labeling, unclear with information supplied if a food allergen. is present
cross reactivity
occurs when the proteins in one substance (typically a pollen) are similar to the proteins found in another substance (typically a food or medication)
active ingredient
our databases give a false sense of security; they only screen for _ interactions
egg
ovum, gallus, albumin
mental health disorders
quality of life is impacted due to stress/anxiety surrounding food allergies; there is an increased risk for _ disorders for the patient and the caregiver
serving size
represents the amount people typically eat; is not a recommendation of how much a person SHOULD eat
active and inactive ingredients
research for _ and _ ingredients in medications being dispensed
product code (strength, dosage form)
second set of numbers in an NDC
added sugar
sugar added during processing
food
the CDC reports _ is the most common cause of childhood anaphylaxis
whites
the _ of the egg contains all the allergenic protein, patients with an egg allergy must avoid all eggs completely
calories
the number of servings you consume determines the number of _ that you eat
avoid the food allergen
the only way to prevent a serious allergic reaction to a food is to _
package sizes and types
third set of numbers in an NDC
FALCPA
this law requires that food labels show in plain English when a "major food allergen" or any ingredient that contains protein from a major food allergen is added as an ingredient in that product
wash hands or use water based wipes
to avoid cross contamination, you should _ after eating in the pharmacy
inactive ingredients
understand that current pharmacy databases SO NOT screen appropriately for _
precautionary statement
unregulated (not regulated by FDA), unverified, voluntary by manufacturer
CeraVe Vanicream
what are products that are appropriate for use by patients with damaged, eczematic skins
milk egg peanut soy wheat tree nut shellfish fish (sesame)
what are the top food allergens
a legume
what is a peanut?
-same amount of active ingredient -same dosage form -same strength
what makes drug products pharmaceutically equivalent?
all (including food)
when asking patients about allergies, make sure to ask about _ allergies
-OTC products have drug fact labels, not package inserts -something on label is unclear
when would you call a manufacturer regarding allergen questions?
contraindications warnings/precautions description
where can we look in the package insert to see the active and inactive ingredients in medications that are being dispensed?
within the ingredient list
where top 9 are listed as its common name, or the common name is listed in parentheses following the name of the ingredient
after the ingredient list in a contains statement
where would you find a statement such as "contains wheat, milk, and soy"
-fresh metas, fruits, and veggies -restaurant foods that are places in a carry out box for an individual customer order -highly refined oils
which foods are not covered by FALCPA?