Allergies Flashcards
What do food allergies affect?
Food allergies affect 1 in 13 children and send a person to the ER every 3 minutes.
What is the most common cause of childhood anaphylaxis according to the CDC?
Food.
What other conditions do many children with food allergies report?
- Asthma
- Eczema or skin allergy
What accounts for at least 15% of patients with food allergies?
Adulthood diagnosis.
What percentage of adults report the development of at least one food allergy after 18 years of age?
Nearly 50%.
What accounts for 20% of hospitalized patients and affects up to 10% of the US population?
Adverse drug reactions.
What accounts for 10% of all adverse drug reactions?
Hypersensitivity reactions.
In addition to food, what causes a large percentage of anaphylaxis?
Medications.
What are some family costs associated with food allergies?
- Special allergen-free foods
- Copayments for health insurance and medications
- Transportation
- Safe childcare
What are some healthcare costs associated with food allergies?
- Emergency department visits
- Hospitalizations
- Office visits
What challenges do lower-income families face regarding food allergies?
- Lack access to allergen-free foods
- Rely more on primary care physicians than specialists (allergists)
- Children in households with lower income incurred 2.5 times the ER and hospitalization costs than higher-income children
What is impacted due to anxiety/stress for both patient and caregiver?
Quality of life.
What is the increased risk for mental health disorders for patients and caregivers?
- Depression
- Anxiety
- Eating disorders
What can help mental health for those with food allergies?
- Psychotherapy
- Support groups/networking
What does the dual exposure theory suggest?
Exposure through skin promotes sensitization but through the GI-tract, tolerance.
What gene is associated with IgE-mediated food allergy in infants according to a 2017 study?
SPINK5.
What foods have been suggested to cause sensitization via the skin?
- Goat cheese
- Wheat
- Oat
- Peanut
What should not be used on damaged, eczematic skins due to the risk of sensitization?
Foods.
What are the top 9 allergens in the US?
- Milk
- Egg
- Peanut
- Tree nut
- Soy
- Wheat
- Sesame
- Shellfish
- Fish
What act labeled sesame as a ninth major food allergen?
Food, Allergy Safety Treatment, Education, and Research Act (the FASTER Act).
What does the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 require?
FDA enforces the regulations requiring companies to list ingredients on packaged foods and beverages.
What does FALCPA provide guidance on?
Ways to assess and manage allergen hazards in foods.
How must FALCPA-regulated allergens be labeled?
- Within the ingredients list
- Immediately after or next to the ingredient list in a ‘CONTAINS’ statement
If allergens are listed within the ingredients list, how must they be presented?
As a common name or common name in parentheses following the name of the ingredient (ex. flour (wheat)).
Is a ‘contains’ statement required?
No, allergens can be listed only in the ingredient list.
What are highly refined derivatives not considered by the FDA?
Allergens.
What are examples of highly refined oils?
Soybean oil, peanut oil, etc.
Why are highly refined derivatives not included by the FDA?
FDA says ‘MOST’ people don’t react to them.
Are allergen processing warnings required by the FDA?
No.
What does FALCPA labeling requirements NOT apply to?
- Non-top 9 food allergens
- Drugs (prescription, non-prescription)
- Cosmetics
- Personal care products
What kinds of foods does FALCPA not apply to?
- Fresh meats
- Fresh fruits
- Vegetables
- Restaurant foods placed in a wrapper or carry out box for an individual customer order
- Highly refined oils
Do specific types of nuts, fish, or shellfish have to be indicated on the label?
Yes.
Do major food allergens contained in dyes, spices, flavorings, additives, and processing aids have to be listed on labels?
Yes, if they contain a major food allergen.
What types of pre-packaged foods are required to have a label that lists major food allergens?
- Imported
- Domestic
What is direct cross-contact?
Allergen was applied then removed.
What is indirect cross-contact?
Allergen was not directly applied.
What should you use to wash utensils, cutting boards, and pans?
Soap and water.
When making several foods, what should you cook first?
Allergy-safe foods.
What should you keep safe foods covered and away from?
Other foods that may splatter.
What will remove a food allergen?
- Soap and water
- Commercial wipes
What will not remove an allergen?
- Sanitizing gels
- Water alone
What should you scrub down with soap and water after making meals?
- Counters
- Tables
What should you not share?
Food, drinks, or utensils.
What is cross-contact or contamination?
A food allergen contaminates another food that is naturally free from the allergen.
In the pharmacy setting, what is cross-contact or contamination called?
Adulteration.
What are precautionary statements?
- Unregulated
- Unverified
- Voluntary
Can people be allergic to any foods?
Yes.
What should a food, medication, or personal care product NEVER be labeled as?
Safe for ANY food allergy patient.
What occurs in allergic reactions due to cross-reactivity?
The proteins in one substance (typically pollen) are similar to the proteins found in another substance (typically a food).
What percentage of people with latex allergy have sensitivity to one or more fruits?
30 - 50%.
What are examples of fruits that may cause sensitivity in latex allergy patients?
Avocado, banana, chestnut, and kiwi.
What does food allergy involve?
Immune system.
What does food intolerance involve?
Digestive system.
Is milk protein allergy the same as lactose intolerance?
No.
What does the form of allergen matter?
- Allergic with contact
- Tolerate baked
- Allergic if ingested
- Allergic if airborne
What can you use to remove food proteins from surfaces?
Common cleaners or water.
What can you use to remove food proteins from hands?
Soap and water or water-based wipes.
What actions can cause allergic reactions due to allergens being carried?
- Saliva
- Semen
- Organic fluid
What does serving size represent?
The amount people typically eat.
What does a nutrition label include?
- Serving size
- Calories
- Total fat (saturated and trans)
- Cholesterol
- Sodium
- Total carbohydrate
- Protein
- Vitamin D
- Calcium
- Iron
- Potassium
What percentage or less of daily value is considered low?
5%.
What percentage or more of daily value is considered high?
20%.
What must medical professionals, especially pharmacy staff, specifically ask about when screening patients?
Food allergies.
What are ways to keep patients safe?
- Asking about ALL allergies
- Avoiding cross-contamination
- Research for active AND inactive ingredients in medications being dispensed
- Thorough counseling on Epinephrine Devices
How should allergens be documented?
In a meaningful, effective manner.
What do our databases currently NOT screen appropriately for?
Inactive ingredients.
How to research for active AND inactive ingredients in medications being dispensed?
- Contraindications
- Warnings/precautions
- Description
What are tertiary resources for researching active AND inactive ingredients?
- Clinical Pharmacology
- Facts & Comparisons
- www.glutenfreedrugs.com
What should you give the patient/caregiver?
A copy of the ingredients.
What is an excipient?
A substance formulated alongside the active ingredient of a medication, included for the purpose of long-term stabilization, bulking up solid formulations, or to confer a therapeutic enhancement.
Where are excipients contained?
Most prescription medications, over the counter products, cosmetics, and personal hygiene products.
What are examples of excipients?
- Oils
- Dyes
- Coloring
- Additives
Where is the first place to look for excipient information?
PI at active and inactive ingredients.
What are dextrans/malodextrins?
Partially hydrolyzed corn or potato starch/Extracted from corn, wheat, potato, or rice.
What are dextrins/dextrose?
Can be obtained from corn, wheat, rice, or tapioca/Powdered corn starch.
What is gelatin obtained from?
The skin, white connective and bones of animals.
What is lactose commercially produced from?
Cow’s milk.
What is pregelatinized starch derived from?
Corn, wheat, potato, or tapioca.
What is sodium lauryl sulfate a derivative of?
The fatty acids of coconut oil.
What is sodium starch glycolate usually derived from?
Potato but can be from corn, wheat, or rice.
Where are food allergens often found in medications?
Inactive ingredients.
Where can the food be clearly identified in the package insert?
- Contraindications
- Warnings and Precautions
What ingredients are NOT screened for and do NOT flag on most interaction databases?
Inactive ingredients.
What happens when inactive ingredients do flag?
They do not hard stop like active ingredient allergens.
What should you note about A-rated generics?
They can automatically be substituted but may differ in excipients.
What does the first segment of the NDC represent?
Manufacturer (labeler).
What does the second segment of the NDC represent?
Product code (strength, dosage form).
What does the third segment of the NDC represent?
Package size, types.
What does NDC apply to?
Prescription and OTC medications.
Does an NDC number mean it is FDA approved?
No.
Should people allergic to eggs still get the flu shot?
Yes.
What do OTC products have?
Drug fact labels, not package inserts.
When should you call a manufacturer?
When something on a PI or label is unclear.
How to find a manufacturer’s phone number?
- Facts & Comparisons
- Clinical Pharmacology
- Product label
What are examples of OTC products you should consider?
- Lotions/creams
- Hair products
- Vitamins/minerals
- First aid products
- Soaps/bathing products
- Personal lubricants/condoms
- Oat (Aveeno TM products)
What is the scientific name for almond?
Prunus amygdalus.
What is the scientific name for apricot?
Prunus armeniaca.
What is the scientific name for coconut?
Cocos nucifera.
What is the scientific name for corn?
Zea mays.
What is the scientific name for egg?
Ovum, albumin.
What is the scientific name for macadamia/bush nut?
Macadamia ternifolia, m. integrifolia.
What is the scientific name for milk?
Lac (cow’s milk - Bos taurus).
What is the scientific name for oat?
Avena sativa.
What is the scientific name for peanut?
Arachis.
What is the scientific name for sesame?
Sesamum.
What is the scientific name for walnut?
Juglans regia and other Juglan species.
What is the scientific name for wheat?
Triticum aestivum, T. durum and other Triticum species.
What has been shown to result in significant decreases in latex allergy prevalence?
Introducing powder-free gloves.
What do our databases only screen for?
Active ingredients.
What is the recommended good dating on epinephrine products?
One year.
What does FARE stand for?
Food Allergy Research Education.
