Winter 2014

Research Update

Winter2014-Research

Food allergy – Epidemiology, pathogenesis, diagnosis, and treatment

Highlights: Medical aspects of IgE mediated (immediate) food allergy are reviewed. It was written by two prominent American allergists and is an excellent summary of recent research.

Application to Dietetic Practice: Dietitians specializing in food allergy would greatly benefit from this article. However, it may be too detailed for dietitians with allergy as a minor part of their practice

Pub Med Link

Introduction of complementary foods and the relationship to food allergy

Highlights: This observational study found that starting complementary foods prior to 17 weeks was associated with development of food allergy. Infants that were breastfed during introduction of cow’s milk had a lower rate of food allergy compared to infants that were not breastfed when cow’s milk was introduced. These results support the current recommendations for introducing solids at 4 – 6 months (US) and 6 months (Canada) with continued breastfeeding.

Application to Dietetic Practice: Continued breastfeeding during weaning, may improve tolerance. When discussing this issue with clients, “may” is more appropriate than “will”. Since this is an observation study, the findings suggest a potential relationship, but do not prove breastfeeding improves tolerance. The effect of breastfeeding on the infant’s immune system is very complicated, and research on this topic is conflicting.

Web Link

A majority of parents of children with peanut allergy fear using the epinephrine auto-injector

Highlights: Parents of children that had been prescribed epinephrine auto-injector were surveyed, and a majority were fearful of using the epinephrine auto-injector.

Application to Dietetic Practice: When counselling clients that have been prescribed with an epinephrine auto-injector, a brief assessment of their confidence and competence should be included in the nutrition assessment.

Web Link

Nickel Oral hyposensitization in patients with systemic nickel allergy syndrome

Highlights: Systemic nickel allergy syndrome is defined by contact dermatitis to nickel (e.g. a rash from wearing nickel containing jewellery) and dermatitis/gastrointestinal symptoms with oral consumption of nickel. In this study, subjects with systemic nickel allergy syndrome had improved tolerance to an oral nickel challenge after oral hyposensitization (gradually consuming increased nickel dosage over approximately one year).

Application to Dietetic Practice: Clients that have been diagnosed with systemic nickel allergy syndrome may benefit from nickel oral hyposensitization. A dietitian would be able to provide this service, in cooperation with the client’s physician.

Pub Med Link

Resources Update

Winter2014-Resources

Allergen Training for the Foodservice and Food Retail Industry

Description: Dietitians working in the food service sector should consider food allergy training for the front line staff. This self-study program helps the staff understand food allergies, identify allergens in menu items, prevent cross contamination, communicate with allergic customers, etc.

Target Audience: Food service staff

Organization: Anaphylaxis Canada

Website Link

 

School Resource Summary

Description: A concise summary with links to federal and state/province laws, guidelines and policies related to accommodating students with anaphylaxis and asthma (separate pages for Canada and the United States). Links to action plan forms are also provided.

Target Audience: School personnel and parents

Organization: Allergic Living

Website Link (US resources)

Website Link (Canadian resources)

Getting Started: A Guide to Celiac Disease & the Gluten-Free Diet

Description: This online booklet is available free of charge and is a great starting point for newly diagnosed celiac patients. Ideally, a client should read this booklet prior to their appointment. It was revised in December 2013 (edited by the NFCA staff and Tricia Thompson, MS, RD).

Target Audience: Newly diagnosed celiac patients (or those that need a refresher)

Organization: National Foundation for Celiac Awareness

Website Link

Your Clinical Questions

Winter2014-Q&A

Can someone have an allergic reaction by smelling peanuts?

Smell alone cannot result in a systemic reaction. However, a reaction can occur if airborne peanut proteins are inhaled. Peanut protein must enter the body for a systemic reaction to occur. The mouth is the usual route, but in rare cases the point of entry is the nose, eyes (peanut protein on the fingers is rubbed on eyes or inside nose) or respiratory tract (inhaled peanut protein). When peanuts are cooked or shelled, peanut proteins may be aerosolized. This could pose a risk, if there are a lot of peanuts in a poorly ventilated room.  Peanut snacks being served on an airplane and restaurants where peanuts are available for everyone to eat are good examples. One person shelling a few peanuts in a large, ventilated room or outside would not aerosolize enough peanut protein to be a problem.

Even though the smell of peanuts will not result in an allergic reaction, it can understandably result in an anxiety attack. These symptoms may be difficult to distinguish from a true systemic reaction.  An epinephrine auto-injector should be used, if there is any possibility of a reaction.

Does coconut need to be avoided in a “nut aware” school?

No, coconut is not actually a nut. The tree nuts of main concern are almonds, Brazil nuts, cashews, hazelnuts (filberts), macadamia nuts, pecans, pine nuts (pignolias), pistachio nuts and walnuts.