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?