Food Allergies and Implication to Patient Safety

What symptom management suggestion would a nurse provide to people with OAS?

If you have symptoms of OAS, avoid eating these raw foods, especially during allergy season because in many patients, OAS worsens during the pollen season of the pollen in question.

Give an example of cross-reactivity.

if you are allergic to ragweed, you may also develop reactions to bananas or melons. This is known as cross-reactivity.

What are some of the food allergy symptoms that are demonstrated with exposure to the allergen?

which cause food allergy symptoms such as itching, hives, swelling, diarrhea, wheezing and a potentially life-threatening reaction called anaphylaxis

Review the link in an Australian study between age of introduction of egg (a rich source of vitamin D) in an infant's diet and food allergies.

A link between late introduction of egg, one of the few common dietary sources of vitamin D in the infant diet, and food allergy has been observed in a large Australian study [10]. Infants who were first given egg earlier (that is between four and six months) had significantly less food allergy than infants first given egg later (that is, after six months of age).

Describe allergy skin tests. What indicates a possible allergy? Is it likely that a patient with a negative skin test has an IgE-mediated food allergy?

Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a small amount of extract made from the food is placed on the back or arm. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy.

Is there a definitive test for OAS? How is OAS determined?

Although there is no definitive test for OAS, affected individuals often have a positive allergy skin test or blood test for specific pollen, along with a history of symptoms after ingestion of the suspected foods.

What questions should a person with food allergies ask when eating away from home?

Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends

What immediate treatment must occur?

An injection of epinephrine and expert care in a hospital

Discuss geography and month of birth and incidence of rates of childhood food allergies.

Areas further away from the equator (and thus with lower ambient ultraviolet radiation [UVR]) have been shown to have higher rates of childhood food allergy-related hospital admissions [4], epinephrine auto-injector prescriptions [4, 5], and peanut allergy (up to six times the risk) [6] than areas closer to the equator. Season of birth (being born in autumn or winter when there is less UVR exposure) has also been associated with higher risk of anaphylaxis [7] and food allergy [8].

Describe cross-reactivity.

Being allergic to a food may also result in being allergic to a similar protein found in something else.

Review the many important aspects of auto-injectable epinephrine and antihistamines used to treat emergency reactions. When symptoms subside, what action must be taken?

Carry and know how to use auto-injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close to you how to use epinephrine and consider wearing a medical alert bracelet that describes your allergy. If a reaction occurs, have someone take you to the emergency room, even if symptoms subside. Afterwards, get follow-up care from your allergist

What is happening in the immune system when cross-reactivity happens?

Cross-reactivity happens when the immune system thinks one protein is closely related to another. When foods are involved it is called oral allergy syndrome (OAS).

List the eight foods responsible for the majority of allergic reactions.

Eggs Fish Peanuts Shellfish Soy Tree nuts Wheat Cow's Milk

What is Eosinophilic Esophagitis (EoE) and its most likely cause? Discuss the family history link of EoE.

Eosinophilic Esophagitis (EoE) is an allergic condition causing inflammation of the esophagus. Most research suggests that the leading cause of EoE is an allergy or a sensitivity to particular proteins found in foods. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, dermatitis or food allergy.

Describe the pathophysiology of food allergy. When are many food allergies first diagnosed?

First diagnosed in young children. Your immune system overreacts to a particular protein found in that food.

Give an example of delayed food allergy.

Food Protein-Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, is a severe condition causing vomiting and diarrhea. In some cases, symptoms can progress to dehydration and shock brought on by low blood pressure and poor blood circulation. Much like other food allergies, FPIES allergic reactions are triggered by ingesting a food allergen. Although any food can be a trigger, the most common culprits include milk, soy and grains. FPIES often develops in infancy, usually when a baby is introduced to solid food or formula.

What are the risks to eating even a small amount of a food allergen? How does this connect with avoidance plans?

However, eating even a small amount of the food, such as that left on cooking utensils or from a food processing facility, can cause a life-threatening reaction. This is why reading the ingredients on food labels and asking questions about prepared foods are an essential part of avoidance plans.

What is the concern with those with birch tree pollen allergy who have mouth itching with peanuts, almonds and hazelnuts?

If mouth itching is noted with nuts, you should see an allergist /immunologist because mild mouth symptoms may signal a more serious allergic reaction to nuts.

"i get a little itchiness on the top of my mouth when i eat nuts"

If patient has an allergy to birch tree pollen

What is the connection between birch tree pollen and apples and celery? Why does this reaction occur in 50-75% of adults with birch tree pollen allergy? What is this called?

If you suffer from hay fever (allergic rhinitis) caused by pollen, your mouth or throat may become itchy after eating an apple or celery. This happens in up to 50 to 75% of adults allergic to birch tree pollen. This reaction occurs because the proteins found in some fruits and vegetables are very similar to those found in pollen. These proteins can confuse the immune system and cause an allergic reaction or make existing symptoms worse, which is referred to as cross-reactivity. In the case of pollen and foods, the result of cross-reactivity is called oral allergy syndrome (OAS) also known as pollen fruit syndrome (PFS).

What teaching should be included when advising a pregnant woman regarding vitamin D? What is the rationale for that teaching?

If you're pregnant, ensuring you have adequate vitamin D (particularly in late pregnancy) is essential to ensuring your child will have adequate levels. Infants' vitamin D stores in the first year of life rely on the mother's stores before birth.

Are there at times false positives with skin and blood tests for food allergy? Discuss the evidence underlying IgE blood testing.

In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend an IgE blood test. False positive results may occur with both skin and blood testing. IgG blood testing is not recommended, as it is unproven in diagnosing food allergies.

Review the results of another Australian study of infants and levels of vitamin D.

In this Australian study, infants with low vitamin D were more likely to have egg or peanut allergy and were more likely to have multiple allergies compared to infants with normal vitamin D levels.

What major roles does vitamin D play in good health?

It plays a major role in the maintenance of healthy bones by helping the body to absorb calcium and also has an essential role in immune system function.

Can vitamin D reverse food allergies? Is there evidence suggesting that vitamin D may protect against food allergies?

It's too early to say whether vitamin D can reverse food allergies. Future research is needed to answer that question. However, research is beginning to support the idea that vitamin D can protect against food allergies and vitamin D is important for overall good health.

Examine outgrowing food allergies. Which allergies are often outgrown? Which allergies persist through adulthood? How do parents determine when food allergies are resolving?

Most children outgrow their allergies to cow's milk, egg, soy and wheat, even if they have a history of a severe reaction. However, peanut, tree nut fish and shellfish allergy tend to persist through adulthood. Repeat allergy testing with your allergist can help you learn when you or your child's food allergies are resolving with time.

What is the impact of cooking or digestion in the intestines on food allergens? How about the research regarding heat and children with milk and egg allergies?

Most food allergens can cause allergic reactions even after they are cooked or have undergone digestion in the intestines, although research is showing that more than half of children with milk and egg allergies can tolerate extensively heated milk and egg in baked foods.

Is there a cure for food allergy? What are the keys to managing food allergies?

Nope. Avoidance, education and preparedness are the keys to managing food allergy.

What are three ways to reduce cross-reactions with food for those with OAS? What is the rationale for these suggestions?

One way to reduce cross-reactions with food is to bake or microwave the food because high temperatures break down the proteins responsible for OAS. Eating canned food may also limit the reaction. And, peeling the food before eating may be helpful, as the offending protein is often concentrated in the skin.

What are food challenges? Should food challenges take place at home?

Oral food challenges can confirm the diagnosis and are done by consuming the food in a medical setting to determine if it causes a reaction. Food challenges should not take place at home.

What do people with food allergy always carry? What are symptoms of anaphylaxis? What action should the person with food allergy when symptoms of anaphylaxis occur in the context of eating?

People with food allergy should always carry auto-injectable epinephrine to be used in the event of an anaphylactic reaction. Symptoms of anaphylaxis may include difficulty breathing, dizziness or loss of consciousness. If you have any of these symptoms in the context of eating, use the epinephrine auto-injector and immediately call 911. Don't wait to see if your symptoms go away or get better on their own.

What is the relationship between vitamin D levels and food allergies levels?

Research using direct measures of vitamin D from blood samples have also shown an association between low vitamin D and increased risk of allergic sensitization in children and adolescents [9] and food allergy in infants [11].

Discuss food allergens that cause allergic reactions in people with a pollen allergy.

Some allergens (usually fruits and vegetables) cause allergic reactions in people with a pollen allergy but only if eaten in raw form. Symptoms in these cases are usually limited to the mouth and throat.

Are food allergies and food intolerances the same? Do they often share similar symptoms? Why are food allergies so significant? As nurses, what do we teach our patients with food allergies?

Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. If you are allergic to a food, this allergen triggers a response in the immune system. Food allergy reactions can be life-threatening, so people with this type of allergy must be very careful to avoid their food triggers. These two share an upset stomach Food intolerance is GI related. Gas, diarrhea, or bloating. does not involve the immune system.

How many and what types and varieties fruits and vegetables are usually involved for a person with OAS?

Some people report symptoms with only one food and others with many different fruits and vegetables. Some people report that only certain varieties of the fruit cause symptoms, for example specific apple varieties.

Can allergy shots have impact on symptoms of OAS?

Some studies have shown that treatment with allergy shots can improve the symptoms of OAS.

Discuss the importance of reading food labels when one has food allergies?

The United States and many other countries require that major food allergens are to be listed in common language (milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soybeans).

What is oral allergy syndrome?

The proteins found in some fruits and vegetables are very similar to those found in particular pollen. These proteins can confuse the immune system in people with food or outdoor allergies. The result is called oral allergy syndrome (OAS) also known as pollen fruit syndrome (PFS)

What are the differences between a food allergy and a food intolerance?

There is a difference between food allergy and food intolerance. A food allergy involves the immune system while food intolerance, such as lactose intolerance, does not. Food intolerance typically involves the GI tract, causing uncomfortable symptoms like abdominal pain, nausea, vomiting and diarrhea, but there is no risk of anaphylaxis

Statistically, in Western countries, approximately what percentages of 12-month old infants have a clinically confirmed food allergy?

Up to 10%

OAS occurs upon what sort of contact? What are the most common symptoms? When do the symptoms usually appear? At what time of the year does OAS occur?

Upon contact of the mouth and throat with raw fruits or vegetables. The most frequent symptoms of OAS include itchiness or swelling of the mouth, face, lip, tongue and throat. Symptoms usually appear immediately after eating raw fruits or vegetables, although in rare cases, the reaction can occur more than an hour later. OAS is generally considered to be a mild form of food allergy. Rarely, OAS can cause severe throat swelling leading to difficulty swallowing or breathing. In a person who is highly allergic, a systemic reaction, called anaphylaxis (an-a-fi-LAK-sis), may be caused by a pollen cross-reactive raw fruit or vegetable, but this is very uncommon. OAS can occur at any time of the year.

What are the risks to exposure to airborne food allergens? What would be likely symptoms?

While exposure to airborne food allergens (e.g., from cooking vapors) usually does not result in anaphylaxis, it can cause a runny nose and itchy eyes similar to a reaction from coming in contact with pollen.

Can children outgrow a food allergy? Can adults develop allergies to particular foods?

While many children outgrow a food allergy, it is also possible for adults to develop allergies to particular foods.

Describe the reaction when an allergen is ingested.

Your immune system reacts by producing antibodies called Immunoglobulin E (IgE)

What are some questions a patient would be asked in the diagnostic process for a food allergy?

asked about the foods you eat, the frequency, severity and nature of your symptoms, and the amount of time between eating a food and any reaction.

What are the food groups with the most likely cross-reactivity?

most common food allergens are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to other members of the same group. This is known as cross-reactivity. Cross-reactivity for other food families is not common.

who gives you the most urgent response?

nut allergy. anaphylaxis in the near future

What occurs in subsequent exposures to the allergen?

the cells release chemicals including histamine

What are the most common causes of Food Protein-Induced Enterocolitis Syndrome (FPIES)?

the most common culprits include milk, soy and grains.

Where do the antibodies attach?

to cells in your skin, lungs and gastrointestinal (GI) tract

When is it advisable for those with OAS to talk with their provider? You should talk to your physician if:

• Your OAS symptoms are causing significant throat discomfort; • Your OAS symptoms are getting progressively worse; • Your OAS symptoms are caused by cooked fruits and vegetables; • Your OAS symptoms are caused nuts; • You develop systemic reactions after eating raw fruits or vegetables such as hives, vomiting or difficulty breathing.