Session 1: Allergic disease The challenges of managing food hypersensitivity

Abstract

Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis. Dietary management: Food allergy: Food intoleranceIn 2004 the European Academy for Allergy and Clinical Immunology and WHO published the revised nomenclature for food hypersensitivity (FHS) as guidance for the management of allergic diseases (1)

Effects of food allergy on the dietary habits and intake of primary schools’ Cypriot children

“…Among the most common food allergens in the pediatric population are milk, wheat and egg (2), which constitute the main sources of significant nutrients, such as protein, iron and calcium (3). An elimination diet creates an emerging need for alternative sources of all basic macro-and micronutrients, as the diet of food allergic children is in several cases found low in energy, protein, calcium, vitamins D and E, iron and zinc (4), due to inappropriate food exclusions and follow-up after diagnosis of food allergies, but also refusal of food allergic children to try new foods (5), resulting to rickets, kwashiorkor, anaemia and failure to thrive in long-term (6).…”

Nutritional management of food protein-induced enterocolitis syndrome

“…Information about which foods to avoid can be obtained from qualified dietitians and credible patient groups such as UK-based (www.allergyuk.org, www.anaphylaxis.org.uk) or USA-based (www.foodallergy.org). Table 2[34] contains information about foods commonly implicated in FPIES and the nutrients they contain.…”

“…Food allergen avoidance advice should ideally be provided by a dietitian [35] and include a discussion on understanding food labels and prevention of cross-contamination, and lifestyle issues such as time taken to shop and eating away from home [34].…”

“…Additional food avoidance not related to any allergic disease, for example, religious reasons, the number of allergens avoided, the period of elimination required and the nutrient content of the foods being avoided will also have an effect [34,36 ▪ ]. The nutritional content of the main foods implicated in FPIES is listed in Table 2[34].…”

Nutritional Aspects in Diagnosis and Management of Food Hypersensitivity—The Dietitians Role

“…The more foods avoided the more important it is to refer to the dietitian [7];general growth monitoring and nutritional assessment, particularly children with growth issues either faltering growth or malnutrition [8];for help and advice on infant formula/milk substitutes and weaning [1];for advice on the general nutritional aspects of the diet and for psychological support [20];for information on life-style issues when living with food allergies such as, eating out, travelling, school trips/camps [21]. …”