Food Allergies

Question 1

What are the Common Food Allergens?

Answer 1

These 8 foods cause 90% of all food allergies:

1) Tree nuts: almonds, walnuts, cashews, and pistachios
2) Eggs
3) Milk
4) Peanuts
5) Soy beans
6) Shellfish
7) Fish: cod, salmon
8) Wheat

Question 2

How to Test for Food Allergens

Answer 2

1) Start with a skin prick test (SPT)

2) Follow up with blood test or skin test

Question 3

What is the Arachis Hypogaea Allergen Powder

Answer 3

1) Fist product FDA approved for food allergy
2) Peanut protein powder from defatted peanut flour
3) Initial dose escalation, up-dosing, maintenance
4) This is not a cure - is meant to prevent a life-threatening reaction

Question 4

Oral Immunotherapy for Food Allergens

Answer 4

1) Protein powder containing food allergen mixed with vehicle food
2) Rapid escalation with variable maintenance
3) Successful oral desensitization as well as tolerance has been described for milk, egg, fish, apple, wheat, tree nut, and peanut
4) 40% of individuals passed OFC after 6 weeks of ceasing OIT treatment for both mild and egg allergy
5) Safety and tolerability limits the use of OIT
- Adverse events more common during escalation phase
- Cochrane meta-analysis of milk OIT: 92% rate of adverse rxns
- Long-term safety and efficacy data lacking
- Necessary length of maintenance phase unknown

Question 5

Dietary Patterns and Supplements for Food Allergy Treatment

Answer 5

1) Mediterranean diet has been associated with a decrease in RAD, Allergic Rhinitis, and weight
2) Probiotics (lactobacillus and bifidobacterium)
- May be helpful for AD, but the data is not strong
- Beneficial for SU when administered with peanut OIT
3) Antioxidants, Folate, Vitamin D - conflicting data
- Neonatal vitamin A supplementation associated with atopy
- Maternal vitamin D supplementation during lactation associated with increased risk of Food Allergy up to 2 years of age
- Vitamin D supplementation during first year of life is currently being studied in Australia (VITALITY study)

Question 6

Food Allergy and Epinephrine Use

Answer 6

1) Food allergy is the most common cause of anaphylaxis in the US (33%)
2) Teach patients and family to use and carry epinephrine
3) Parental training increases the odds of auto-injector availability
4) Among anaphylaxis fatalities, 14% had early and repeated administration of epinephrine
5) The three Cardinal Rules of Epinephrine use:
- Think Epi, Use Epi
- Once the unit clicks, count to 10
- Call 911 after giving the dose

Question 7

Medical Therapies for Food Allergens

Answer 7

1) Epinephrine
2) Dietary patterns and supplements
3) Biologics

Question 8

High-Risk Areas for Food Allergies

Answer 8

1) Accidental exposures occur in 58% of food allergy patients during a 5-year period and 75% during a 10 years period
2) Restaurants, bakeries, and ice cream shops
3) Airplanes
4) Birthday parties

Question 9

Management Strategies for Food Allergies

Answer 9

1) Avoidance
2) Medical Therapies
3) Desensitization
4) Achieving oral tolerance