FREEDOM FOODS GROUP LIMITED PROVIDES THIS TRUSTED RESOURCE FOR PARENTS AND CARERS OF CHILDREN LIVING WITH FOOD ALLERGIES AND INTOLERANCES, TO PROVIDE INFORMATION WE TRUST YOU WILL FIND USEFUL.
Whether your child has just received a diagnosis following a severe allergic reaction or finally received a diagnosis after months of unexplained tummy troubles or rashes, we’re here to help.
If you are new to food allergy or food intolerance, it is normal to feel overwhelmed by the changes to your child’s diet and lifestyle. Overtime and as your knowledge and management expertise grows, we’re confident it will begin to feel more normal.
This information offers a rich source for information which may help you understand food allergy and food intolerance a little better, and serve safe food. We hope that the information provided within is a source of confidence and that it may even help children to self-manage their food allergies and intolerances more independently.
All our resources are carefully reviewed by our team of Dietitians . However, please be sure to always talk to your child’s Healthcare Professional for individual management advice.
Food allergy is a medical condition where exposure to a particular food can trigger a harmful immune response, which is called an allergic reaction. For instance, some proteins in food can trigger our immune systems to mount an attack against the protein, which would ordinarily be harmless to most other people. The proteins that trigger the reaction are called allergens. Even small amounts of an allergen can cause a reaction in people with food allergies.
Experts believe that as many as 15 million Americans have food allergies, including around 5.9 million children under 18 years of age. That means 1 in 13 children, or around 2 kids in every classroom are affected by food allergies. By the way, about 30% of kids with food allergies are allergic to more than one food. Some reports also highlight that the prevalence of food allergy is increasing.
While the cause of allergy is still being researched, factors such as hygiene, limited exposure to bacteria during early childhood and changes to gut bacteria composition (called the ‘hygiene hypothesis’), obesity, Vitamin D deficiency and environmental factors may all be involved.
Currently, there is no treatment for food allergy: it can only be managed by complete avoidance of the food which causes the allergy. Diagnosing food allergy may also be difficult, because non-allergic reactions to foods, called food intolerances may be confused with food allergy (see later section on food intolerance).
Allergens can be found in many common places, including food. Although various foods and food components are known to be food allergens, most allergic or immune system reactions result from exposure to a small number of common foods. Eight foods account for 90% of all food-allergic reactions: peanuts, tree nuts (e.g. walnuts, almonds, cashews, pistachios, pecan nuts), milk, eggs, wheat, soy, fish and shellfish(3, 4). Allergy to sesame is also an emerging concern.
When a person comes into contact with an allergen to which they are allergic, an allergic reaction occurs. This involves the body’s immune system generating an ‘attack response’ to the allergen, because it thinks the allergen is an enemy invader.
THE SYMPTOMS OF AN ALLERGIC REACTION TO FOOD CAN RANGE FROM MILD TO SEVERE
– Itchy mouth
– Throat tightening
– Difficulty breathing
Some allergic reactions can take a bit of time to show up, with the body’s immune system taking several hours or even days to show symptoms. These more delayed, onset allergic reactions are tricky to diagnose and advice from an expert allergy doctor is needed.
Anaphylaxis, on the other hand, is a serious and life threatening allergic reaction that is sudden in onset. Anaphylaxis reactions often occur soon after exposure to an allergen (i.e. often within minutes) and involve the body producing antibodies called IgE antibodies. Other biochemical changes occurring during anaphylaxis manifest in difficulty in breathing and someone experiencing anaphylaxis needs immediate lifesaving medical treatment is needed.
Any person at risk of Anaphylaxis reactions should always have an Anaphylaxis Management Plan in place. You can learn about Anaphylaxis from the Food Allergy Research & Education (FARE) website at: www.foodallergy.org/life-with-food-allergies/anaphylaxis/about-anaphylaxis. Take the time to review this excellent resource.
WHAT IS CELIAC DISEASE?
Celiac disease is an autoimmune disease, which means the body’s immune system mistakenly attacks itself when it senses a particular trigger. Experts believe that the cause of celiac disease involves interaction between a person’s genetic background and the environment.
With celiac disease, the trigger is a protein called gluten, which is commonly found in wheat, rye, barley, triticale, malt, brewer’s yeast, wheat starch and their by-products (see Table 1 for more information). It is estimated to affect 1 in 100 people worldwide and up to 3 million Americans. Children and adults can develop celiac disease at any age. In children, this can be as young as around six months, which is about the time solid foods containing gluten are introduced.
The lining of the small intestine is covered with small, finger-like projections called villi. If you or your child has celiac disease, eating foods with gluten inflames and damages the villi and the small intestine, via an immune system response to the gluten protein.
One of the consequences of the damage to the small intestine is that food and nutrients are absorbed poorly. This can result in bowel symptoms and various nutrition deficiencies, including iron deficiency. Inflammation also results in problems that can affect the bones, joints, skin and other organs.
Importantly, appropriate treatment with a strict avoidance of gluten in the diet leads to small bowel healing, resolution of symptoms, and a reduction in the risk of complications. Untreated celiac disease and poor management can lead to chronic poor health.
HOW IS CELIAC DISEASE TREATED?
Right now, there is no cure for celiac disease, but fortunately it can be managed by following a strict, lifelong, gluten-free diet. Sticking to a gluten free diet is very important considering even trace amounts of gluten can damage the small intestine, with or without obvious signs or symptoms.
Someone with celiac disease needs to be a gluten super sleuth, and check food labels and ingredient lists carefully to make sure there are no gluten containing ingredients. See Table 1 for an example list of gluten- containing grains.
GLUTEN-CONTAINING GRAINS AND THEIR DERIVATIVES
Varieties and derivatives of wheat such as:
- Wheat berries, Durum wheat, Emmer, Semolina, Spelt, Farina, Farro, Graham, KAMUT® Khorasan wheat, Einkorn wheat
- Wheat Starch that has not been processed to remove the presence of gluten to below 20 ppm and adhere to the FDA Labelling Law Rye
Malt in various forms including:
- malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavouring, malt vinegar
- Brewer’s Yeast
- Wheat Starch that has not been processed to remove the presence of gluten to below 20ppm and adhere to the FDA Labeling Law*
*According to the FDA, if a food contains wheat starch, it may only be labeled gluten-free if it has been processed to remove gluten, and tests show it is below 20 parts per million gluten. If a product labeled gluten-free contains wheat starch in the ingredient list, it must be followed by an asterisk explaining that the wheat has been processed sufficiently to adhere to the FDA requirements for gluten-free labeling.
List adapted from: Celiac Disease Foundation. Gluten-Containing Grains and Their Derivatives.
For comprehensive lists of foods and ingredients to avoid when managing celiac disease, see the Celiac Disease Foundation website www.celiac.org/live-gluten-free/glutenfreediet/sources-of-gluten.
Perhaps more importantly, for a comprehensive lists of foods that you can eat when living with celiac disease, see the Celiac Disease Foundation website for ‘What Can I Eat?’
CELIAC DISEASE LONG-TERM MANAGEMENT
Adjusting to the gluten free diet may seem difficult at first, but as knowledge and confidence grows, managing the diet becomes easier. When first diagnosed, a visit to a registered nutritionist or dietitian who specializes in gluten free diets is advised. They will help to explain and plan your individual gluten-free diet, give you information about how to read food labels, and will help you to plan to get all the right nutrients your body needs. This may involve considering the need for any dietary supplements like iron or calcium. A dietitian may also give you some nice recipe ideas.
Once gluten is eliminated, the small intestine can heal and you or your child should start to feel better, usually within a few days or weeks.
READING LABELS ON ALL FOODS FOR GLUTEN CONTAINING FOODS
There are many foods that could contain gluten, often in hidden or unexpected ways, so remember to always read packaged food labels to check for hidden gluten sources. Some tips include:
- In America, a gluten-free claim can be made if the food contains no detectable gluten
- Most packaged foods must declare ingredients derived from a gluten-containing grain (i.e. wheat or rye) on the food label’s ingredient list
- If “gluten-free” is not specified on a food label, always read the label very carefully
Be careful, as many products may appear to be gluten-free, but are not. For instance, products labeled wheat-free are not necessarily gluten-free. They may still contain spelt (a form of wheat), rye or barley-based ingredients that are not gluten-free. To confirm if something is gluten-free, read the product ingredient list.
To learn more about label reading as it relates to identifying gluten in food, see the Celiac Disease Foundation advice on Label Reading and The FDA www.celiac.org/live-gluten-free/glutenfreediet/label-reading.
OTHER CONSIDERATIONS WITH CELIAC DISEASE
Preschool or school:
Having a child’s school involved may help in the day-to-day management of maintaining a gluten free diet. Some helpful tips:
- Talk with your child’s preschool or school and let them know that your child needs to follow a strict gluten-free diet
- Discuss with your child’s class room teacher whether you and your child may have some ‘circle-time’ with the class, to explain the basics about celiac disease. This is a nice way to build education and tolerance, all at once
- Exercise care around bake sales, classroom parties and snacks outside of the cafeteria.
Keeping gluten-free food separate at home:
It’s important to keep gluten-free food separate from gluten-containing food, to avoid accidental exposure to gluten. Some helpful tips include:
- Prepare and store all gluten-free foods away from foods with gluten. Use separate chopping boards and utensils when preparing or cooking gluten-free foods
- Clean utensils and appliances that might have gluten-containing foods, even crumbs, on them
- A separate toaster for gluten-free bread is best practice.
Taking care when you eat out
Eating out is always a treat and having celiac disease is no reason to stop. However, a little extra care is needed to make sure gluten containing food is not eaten by mistake:
- Pay attention to choose gluten-free menu items
- Inform restaurant staff that you or your child can only eat food that is strictly gluten-free
- Avoid condiments and food that may have been cooked with hidden (i.e. soy sauce).
WHAT IS NUT ALLERGY?
Like other food allergies, peanut and tree nut allergies occur when the body’s immune system responds to a normally harmless protein in nuts, as if it were toxic. Therefore, a person who is allergic to nuts will have a reaction after consuming nuts. It is possible to have an allergy to a single type of nut, or several different nuts.
Peanut and tree nut allergies are amongst the most common food allergies. Between 0.6-1.3% of Americans have peanut allergies, whilst for tree nut allergies, the prevalence is around 0.4-0.6%(4). By the way, people who have peanut allergy have an increased chance of being allergic to tree nuts.
Peanut and tree nut allergies are most common in infants and young children, but can also appear for the first time in adults. Both peanut and tree nut allergies are usually life-long once acquired. Studies show that about 20% of children who are allergic to peanut will outgrow their peanut allergy(6), and around 9% of children allergic to tree nuts may outgrow their allergy(7).
Allergic reactions to peanuts and tree nuts may be very serious and any suspected allergic reactions to peanut/tree nut should be referred to immediate medical assistance.
Learn about the severe and potentially life-threatening allergic reaction called anaphylaxis from the Food Allergy Research & Education (FARE) website at www.foodallergy.org/life-with-food-allergies/ anaphylaxis/about-anaphylaxis. This is an excellent resource.
HOW IS NUT ALLERGY TREATED?
Those with nut allergy must avoid the allergenic nut in all forms, including nut products and foods containing traces of nuts. Avoidance of the allergenic nut is the only proven treatment for peanut, tree nut or seed allergy.
While nuts can look and taste similar, it is possible to be allergic to only one nut or to more than one nut. Discuss what to do about these other nuts with your allergy specialist. Be sure to speak to your allergy specialist or Registered Nutritionist or dietitian about your personal needs or those of your family/children.
Any product containing nuts, even in tiny amounts must include that information on the food label. However, peanuts and tree nuts can be found in a variety of foods and often in food we do not suspect, including cereals, muesli bars and bakery items. So, it is really important to read and understand foods labels and to choose appropriate foods.
For a comprehensive list of foods and ingredients to avoid when managing peanut and tree nut allergies, see the Food Allergy Resource & Education resources at the bottom of this page.
READING LABELS ON ALL FOODS FOR NUT CONTAINING FOODS
The Food Allergen Labeling and Consumer Protection Act requires that all packaged foods regulated by the FDA list allergens on the ingredients’ label, if the product contains an allergen. You should always read the entire ingredients’ label to look for the names of peanut and/or the tree nut(s) that you need to avoid. Peanut and/or tree nut ingredients may be within the ingredients’ list, or could be listed in a “Contains” statement beneath the ingredients’ list.
Advisory statements such as “may contain” or “made in a facility” with the allergen are voluntary and are not required by any federal labeling law. These statements indicate that the food may be made in a facility that makes other foods containing peanuts or tree nuts, or that there is a chance the raw ingredients may have been contaminated with peanuts or tree nuts. However, the food may not contain peanuts or tree nuts as an intentional ingredient. As such, discuss with your allergy specialist whether you need to avoid such foods.
You may learn more about the US food allergen labeling law at www.kidswithfoodallergies.org/page/ label-law-food-allergen-labeling-consumer-protection-act.aspx.
Unlabeled food or food consumed outside the home generally poses a much higher risk that food labeled as possibly containing traces. Again, discuss what to do about these foods with your allergy specialist. Prepared food that is not labeled (such as those from cake shops, food malls and restaurants) may contain or be contaminated with peanuts or tree nuts, so be sure to take care with such products.
As you can never totally remove the risk of accidental exposure to your allergen trigger, you should always have your anaphylaxis management plan on hand. For parents of children with anaphylactic allergies, it is best practice to make sure that schools and careers are also informed about allergy and anaphylaxis management plans. Learn more about anaphylaxis from the Food Allergy Research & Education (FARE) website at www.foodallergy.org/life-with-food-allergies/anaphylaxis/about-anaphylaxis.
OTHER CONSIDERATIONS WITH NUT ALLERGY
Preschool or school
In childcare centers and preschools, the risk of a food reaction is high. Some centers request that all parents refrain from including nut containing foods in their children’s lunch boxes, to reduce risks. Here are some other tips you can apply:
- Organize a meeting with staff caring for your child to discuss how best to manage risks
- Pack your child’s food
- Teach your child the importance of eating only his or her own food and not to swap or share food.
- Keeping Children with Food allergies Safe at School: A one-page download of important recommendations from the CDC guidelines. www.foodallergy.org/sites/default/files/2017-09/cdc-keeping-children-safe.pdf.
- Recommended Practices for Reducing the Risk of Exposure to Food Allergens and Responding to Food Allergies in Schools and Early Childhood Education Programs: A two-page download of recommended practices and accommodations for the classroom, cafeteria, transportation, school events, and physical education and recess www.foodallergy.org/sites/default/files/2017-08/cdc-reducing-risk.pdf.
Taking care when you eat out:
A little planning may make all the difference to the enjoyment of a night out. Tips for eating out include:
- Consider contacting the restaurant or friend in advance to inform them of the food allergy
- Don’t just rely on the menu descriptions of what is in the food and do ask questions
- Talk to the waiting staff about any dishes you should avoid and express concerns to avoid cross contamination
- Have a small snack before you go out, so that you are not so hungry and can always take care
- Cautiously touch test a small amount of the food on your outer lip before putting it into your mouth
- Have your Action Plan for Anaphylaxis with you.
For those who are at risk of anaphylaxis, an automatic device for giving adrenalin (medication for anaphylaxis), will be prescribed by a doctor, who will instruct how to use the device. This will need to be carried at all times. It’s also important that family members, carers, babysitters, schools and anyone involved in caring for children with allergies know how and when to administer the medication if required.
WHAT IS FOOD INTOLERANCE?
Food allergies are different from food intolerances. The difference between the two is that a food allergy involves the immune system, whereas an intolerance reaction does not involve an immune system response. The body processes involved in food intolerance responses are not fully understood, but seem to involve metabolic, toxicological and/or pharmacologic reactions(8). While people commonly confuse symptoms of allergy and intolerance, a specialist allergy doctor will confirm whether you or your child has a food allergy.
Intolerances may contribute to uncomfortable and bothersome symptoms, however they do not usually constitute medical emergencies. Perhaps one of the best known examples is lactose intolerance, which may be more correctly called ‘lactose malabsorption’. It is the result of gastrointestinal or gut symptoms that stem from the incomplete digestion and absorption of the milk sugar, lactose. The lactose then makes its way into the large intestine, which is there fermented by bacteria and by-products are produced. Those with Lactose Intolerance may experience gastrointestinal symptoms such as flatus and bloating. Lactose intolerance may be misinterpreted as an allergy to milk by some people, so it is always best to consult your medical professional for advice.
Salicylates are another common food intolerance trigger in sensitive people and these substances are present in many different foods, so that a build-up of salicylates in one’s system can occur through eating a little of it at a time, across many different foods. For more information on intolerance responses to salicylates and other common food intolerance triggers, see information prepared by the Royal Prince Alfred Hospital Allergy Unit in Australia at www.slhd.nsw.gov.au/RPA/Allergy/resources/foodintol/salicylates.html.