Current MNT FOR FOOD ALLERGY AND INTOLERANCE_2025

MNT for Adverse Reactions to Food: Allergy & Intolerance

• Common allergens:

  • Peanuts

  • Tree nuts

  • Milk

  • Eggs

  • Wheat

  • Soy

  • Fish

  • Shellfish

Lesson Objectives

• Understand the difference between food allergy and food intolerance

• Identify common food allergens and intolerances

• Recognize signs and symptoms of food allergy and intolerance

• Learn diagnostic methods for food allergy and intolerance

• Review nutritional implications of allergy and strategies to ensure adequate nutrient intake

• Understand the role of Medical Nutrition Therapy (MNT) in managing food allergy and food intolerance

Terminologies

• Antigen: Molecule that elicits an immune response (e.g., proteins, polysaccharides)

• Allergen: Specific antigen causing an allergic reaction

• Hapten: Inactive compounds that elicit immune response when attached to carrier proteins

• Epitope: Site on allergen recognized by antibodies

• Antibodies: Proteins produced in response to antigens

Additional Terminologies

• Oral tolerance: Body's ability to ingest food without an immune reaction

• Food sensitivity: Unclear whether reactions are immune-mediated or biochemical

• Cross-reactivity: Immune response to similar proteins in different foods

• Oral food challenge (OFC): Medical procedure to diagnose food allergies

Definitions

• Adverse reaction to food (ARF): Undesirable response to food post-ingestion

• Food allergy: Immune-mediated response to food proteins leading to inflammatory symptoms

• Food intolerance: Non-immune response due to body’s inability to digest food components

Mechanism of Food Allergy

• Primary Exposure:

  • Sensitization phase where T-helper cells recognize allergen, prompting IgE production

  • IgE binds to mast cells, preparing the immune system for future exposure

  • No symptoms during sensitization

• Secondary Exposure:

  • Activation phase where re-encounter with the allergen causes mast cell activation

  • Release of histamine and inflammatory mediators leading to allergic symptoms

Classification of Food Allergy

• IgE Mediated:

  • Rapid symptoms post-exposure, detectable via skin prick/blood tests

  • Signs include swelling, hives, abdominal pain, and potentially anaphylaxis

• Non-IgE Mediated:

  • Delayed symptoms (hrs to days), usually not detected by common allergy tests

  • Symptoms include GI discomfort, eczema, irritability in infants

Epidemiology of Adverse Food Reactions

• US: Children >8%, Adults 2-4%

• Ghana: 11% allergic prevalence in children, common allergens include peanuts and tropical fruits

Who is Prone to Food Allergies?

• Individuals with a genetic tendency

• Higher risks if parents have allergies (40% with 1 parent, 60% with 2)

• Males are more likely to have food allergies than females

Common Food Allergens in Children

• Major allergens accounting for 90% of allergies:

  • Peanuts

  • Tree nuts

  • Milk

  • Eggs

  • Soy

  • Fish

  • Shellfish

  • Wheat

• Others account for 10%

Common Food Allergens in Adults

• Peanuts, Shellfish, Fish, Tree nuts, and Seeds

Food Allergy Symptoms

• Gastrointestinal Symptoms:

  • Abdominal pain, nausea, vomiting, diarrhea

• Skin & Mucous Membranes:

  • Hives, angioedema, eczema

• Respiratory Symptoms:

  • Nasal congestion, asthma, cough, wheezing

• Systemic Symptoms:

  • Anaphylaxis, hypotension, dysrhythmias

MNT for Food Allergy: Nutritional Implications

• Poor growth in children from nutrient deficiencies

• Common deficiencies: Calcium from dairy, magnesium from nuts, omega-3 FA from fish

• GI issues from allergenic reactions may further complicate nutrient absorption

MNT for Food Allergy: Assessment

• Anthropometry: Monitor height, weight, and BMI changes

• Biochemical Data: Serum components like albumin and iron

• Detailed dietary history to reveal patterns and triggers

MNT for Food Allergy: Diagnosis

• IgE Mediated: Diagnosed through skin prick tests and food challenges

• Non-IgE Mediated: Identified through elimination diets

MNT for Food Allergy: Nutrition Intervention

• Goals include avoidance of allergens, maintaining nutritional adequacy, and managing symptoms

• Education on reading food labels and identifying safe food alternatives

Dietary Management of Lactose Intolerance

• Avoid high-lactose dairy food, consider lactase supplements

• Fermented products (yogurt, aged cheese) are often tolerated

• Calcium and vitamin D supplementation may be necessary

FODMAPs Intolerance

• FODMAPs can trigger GI symptoms in sensitive individuals

• High FODMAP foods include various fruits, legumes, and certain grains

• Low FODMAP alternatives promote symptom relief and dietary balance

Food Additives & Pharmacologic Agents

• Certain food components can trigger intolerant reactions

• Common offenses include MSG, histamine, and various preservatives

• Failsafe diet: Focuses on avoiding specific additives to aid management

Conclusion

• Key distinctions between food allergy and intolerance must be understood for effective management

• Education, dietary modifications, and ongoing support are critical for individuals with food allergies or intolerances