Fall 2015

Research Update

Fall2015-Research

Prevalence of celiac disease in patients with severe food allergy.

Highlights: This study was conducted by an Italian pediatric allergy clinic. They compared the rate of undiagnosed celiac disease in three groups of children – severe IgE mediated food allergy (requiring oral immunotherapy), mild IgE mediated food allergy (developed tolerance naturally) and healthy controls. Children with mild allergy had similar prevalence to healthy controls (1%), but children with severe allergy had a prevalence of 4 – 5%. Twelve out of the thirteen children diagnosed with celiac disease were asymptomatic.

Application to Dietetic Practice:  These findings suggest that children with severe food allergy should be screened for celiac disease.

Pub Med ID – 26179550

Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens

Highlights: Consensus statement on cross reaction between aeroallergens and food (e.g. patients that are allergic to inhaled plant pollen may have allergic symptoms when eating food with similar allergenic proteins). To my knowledge, there is not a consensus statement on this topic in Canada or the United States. Cross reactions may be more prevalent and the consequence may be more severe and diverse than previous thought.

Application to Dietetic Practice: Dietitians that work with atopic clients or those with diverse allergic symptoms would benefit from reading this article.

Pub Med ID – 26095197

Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria

Highlights: An expert group of gastroenterologists developed a protocol to diagnose NCGS through gluten elimination, blinded reintroduction and systematic symptom recording. The protocol was suggested as a tool to standardize subject selection in research studies. However, it would also be very useful in clinical practice.

Application to Dietetic Practice: This is an excellent resource for dietitians working with elimination diets and food challenges. The protocol could be used to help clients determine if particular foods, such as gluten, are truly affecting their symptoms. The procedure could easily be adapted to other foods (e.g. milk, egg, etc.).

Pub Med ID – 25976434

Web Link

Food protein-induced enterocolitis syndrome and allergic proctocolitis

Highlights: The clinical/laboratory presentation and medical management of these two conditions is compared. Additionally, the detailed description of the acute and chronic presentation of FPIES helps the reader understand the full spectrum of this condition. A concise protocol for oral food challenges is given. Dietary management of FPIES is listed in a table, but is not discussed.

Application to Dietetic Practice: The article is focused on diagnosis and treatment, not dietary management. However, it would still be an informative article for pediatric dietitians.

Pub Med ID – 25976434

Web Link

Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood

Highlights: Cochrane review

Application to Dietetic Practice: There is limited evidence that supplementation has a very modest benefit on allergic development. The evidence is not sufficient to routinely recommend supplementation, but it should not be discouraged, if clients inquire about it.

Pub Med ID – 26197477

Web Link

 

 

Resources Update

Fall2015-Resources

Allerject Recall (Canada)

Description: Epinephrine auto-injectors are important live saving medication for patients with severe IgE mediated allergies. Allerject has recently been recalled. Patients should exchange Allerject devises for EpiPens (although there is currently a shortage).

Target Audience: Health care professionals and the general public

Organization: Sanofi – Allerject

Website Link

Auvi-q Recall (United States)

Description: Epinephrine auto-injectors are important live saving medication for patients with severe IgE mediated allergies. Auvi-q has recently been recalled. Patients should exchange Auvi-q devises for EpiPens (although there is currently a shortage).

Target Audience: Health care professionals and the general public

Organization: Sanofi – Auvi-Q

Website Link

Kyle Dine & Friends – Food Allergy Awareness Video

Description: Kyle Dine is a singer/song writer with a mission to educate children about food allergies. He has travelled to many schools and other events with his upbeat presentations. He has recently produced food allergy education DVD’s with songs, puppets and laughter. The DVD’s are available for two different age groups and in four languages (English, French, Spanish and German). They would be a great resource for elementary schools.

Target Audience: elementary school aged children

Organization: Kyle Dine

Website Link

Anaphylaxis Canada is now Food Allergy Canada

Description: This website is a great resource for Canadians with IgE mediated food allergy. The home page has links on each of the priority allergens.

Target Audience: general public

Organization: Food Allergy Canada

Website Link

Demystifying Oral Food Challenges

Description: Oral food challenges are the gold standard for diagnosing food allergies. However, patients are often reluctant to consume a food that may cause a severe reaction. This PDF handout answers questions about oral food challenges and provides practical tips to prepare.

Target Audience: food allergic general public

Organization: Kids with Food Allergies

Website Link

Your Clinical Questions

Fall2015-Q&A

How strict does an elimination diet for eosinophilic esophagitis need to be?

I am not aware of any research that answers that question, but most dietitians with expertise in this field recommend a very strict diet – including potential cross contact and foods with precautionary labels (e.g. may contain…).