1. Case 1--38 year old man states that he is deathly allergic to onions and must have an onion free diet. Case 2--19 year old man states that he is allergic to peanuts and has avoided them since childhood. Case 3—29 year old female states she is allergic to milk. She requests a substitute for milk in her diet trays.
2. Understand IgE mediated allergic reactions Know the incidence and risk of Food Allergy adverse events. Know how to confirm food allergy by history and testing.
15. Most deaths are teenagers/ young adults >85% are due to peanuts and tree nuts Virtually all had asthma. Virtually all had had a previous severe reaction to the same food. Virtually all did not receive epinephrine in a timely fashion.
16. Right Age?Right Food?Emergency treatment?Allergist? Testing?EpiPen? Medic Alert?Restaurants? Shopping labels?
17. Skin Prick Test Easy to do. Inexpensive. Results in 15 minutes. Requires training and supplies. Great for large jails.
18. ImmunoCap Radioallergosorbent testMeasures IgE to specific antigens. Accurate and predictable. $45.00. Is this cost effective?
19. Positive defined as greater than 2.0kU/L Sensitive but not specific.
20. Sensitive, not specific. If negative, believe it. If positive, the patient still may not be allergic. Expensive--$45.00. May be less expensive than the costs of a special diet.
21. Of those referred to an allergist, <50% are actually allergic. What about those coming into a jail or prison?
22. Ada County Jail is a 1200 bed facility located in Boise, Idaho. Over a two year period, virtually all inmates who stated they had a food allergy were tested.
24. Case 1--38 year old man states that he is deathly allergic to onions and must have an onion free diet. Case 2--19 year old man states that he is allergic to peanuts and has avoided them since childhood. Case 3—29 year old female states she is allergic to milk. She requests a substitute for milk in her diet trays.
25. Risk of anaphylaxis. Food avoidance. Emergency response.
26. HIGHER RISK LOWER RISK Teens to Early 20s Older Previous severe reaction Not the Big 3 foods Peanuts, Treenuts, shellfish No documentation of previous severe reaction
27. Special Diet Kitchen Worker? Cell or dorm where others eat the allergic food?
28. Epipens? Emergency Response?
29. Don’t serve “The Big 3 Foods” Substitute Foods. Testing--skin prick test and CapRAST.
30. Work up protocol Peanuts, fish CapRAST, Skin prick test Tomatoes, onions, etc. History test CapRAST, Skin Prick
31. CATEGORY: MEDICAL AND NUTRITION TOPIC: FOOD ALLERGIES PURPOSE: TO GUIDE APPROPRIATE IDENTIFICATION AND TREATMENT OF PATIENTS WITH FOOD ALLERGIES References. This protocol is based upon the following sources. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter 65—Adverse Reactions to Foods Food Allergy: Diagnosis and Management. Primary Care: Clinics in Office Practice. Vol. 35, issue 1 (March 2008) Rakel: Integrative Medicine, 2nd ed. Chapter 86—Adverse Food Reactions and the Elimination Diet Introduction to food allergies in corrections In a correctional setting, the differentiation of true food allergies from food intolerance (especially simple food aversion) is essential. On the one hand, jails do not want someone with a true food allergy to be served that food and suffer an allergic reaction. On the other hand, most inmates who claim to have a food allergy only have a food aversion and jails cannot feasibly grant a special diet to everyone like this. Inmates who have no true allergy may use the claim of an allergy to avoid foods they do not like, in order to gain status among other inmates and to manipulate staff. The goal of this endeavor is to accurately identify those individuals with a true food allergy and exclude those who do not have a true food allergy. Definitions. Food Allergy refers to an immune-mediated allergic reaction to the glycoproteins in certain foods. ▪ Food allergies are most common in the very young. ▪ Many patients with true food allergies loose the allergy over time. ▪ Several studies indicate that most patients who report a true food allergy are found by diagnostic testing to not have that allergy in fact. ▪ Most cases of true food allergies are to certain foods: nuts, shellfish, eggs. ▪ An estimated 200 people die each year from acute allergic reactions. ▪ Most of these deaths are due to peanut or tree nut allergies. Food Intolerance refers to any non-allergic reaction to food. Food intolerance includes: ▪ Food poisoning due to a toxin. ▪ Side effects of substances found in some foods (example, headache caused by tyramine in wine or racing heart caused by caffeine). ▪ Individuals lacking certain digestive enzymes, such as those with lactose intolerance and those needing pancreatic enzyme replacement. ▪ Food aversion in which patients have a psychological revulsion for certain foods but experience no problems when they ingest that food unknowingly. Adverse Food Reaction includes both food allergy and food intolerance. This term is used when it is not yet known if a patient has a true allergy or not.
32. 38 year old man states that he is deathly allergic to onions and must have an onion free diet. Right Age? Right Food? History--ER? Allergist? Testing? EpiPen? Medic Alert? Restaurants? Shopping labels?
33. 19 year old man states that he is allergic to peanuts and has avoided them since childhood. Right Age? Right Food? History--ER? Allergist? Testing? EpiPen? Medic Alert? Restaurants? Shopping labels?
34. An IgE milk allergy in an adult is rare. The most common causes of milk “allergy” are: Intolerance (eats ice cream and cheese) Lactase deficiency (truly avoids dairy) Treatment is Lactaid—on commissary.
35. Slides Outline Ada County Jail Food Allergy Protocol Questions