What's Up Allergies:
Resources on Living with Multiple Food Allergies
by
Laura Slaathaug
A Thesis
Submitted to the University of North Dakota
Honors Program Committee
In Partial Fulfillment of the Requirements
For Graduation
As a Scholar in the Honors Program
Grand Forks, North Dakota
December 1, 2013
What’s Up Allergies 2
Written in memory of Helen Ramsey
What’s Up Allergies 3
Purpose: To provide a resource for people living with multiple food allergies and to
ascertain a solution for dietitians working with caregivers to help safely feed children a
well-balanced diet
Abstract: Nutrition therapy is important for children coping with multiple food allergies.
Actual rates of referrals to dietitians for food allergy cases are unknown although dietitian
involvement in food allergy treatment has proven beneficial (Venter et al., 2012).
Dietitians may lack resources to treat this target group because of research and education
gaps for multiple food allergies. Dietitians are not alone. Research has reported knowledge
gaps among primary care physicians regarding food allergies (Gupta, 2009) and repeated
dissatisfaction among guardians (Gupta, 2010). Although food allergy patient education
resources have expanded in recent years, more research is needed to develop evidencebased guidelines to treat multiple food allergies. The first step to resolving this issue is
that clinicians such as dietitians educate themselves and disseminate educational resources
for food allergy treatment across and among professional disciplines.
This project
compiled and categorized resources available to caregivers for children with multiple food
allergies.
Introduction
Dietary treatment of food allergies is often overlooked after diagnosis (Venter, Laitinen, &
Vlieg-Boerstra, 2012) (Boyce et al., 2011), and the incidence of food allergies in children
is rapidly increasing (Branum & Lukacs, 2008). Dietitians and other health practitioners
must rise to meet the challenge of treating those affected. In 2007, approximately 3 million
What’s Up Allergies 4
children under age of 18 years (3.9%) reported suffering from a food allergy or digestive
disorder in the last year. From 1997 to 2007, the reports of food allergies increased 18%
among children under the age of 18 years (Branum & Lukacs, 2008). Compared to children
without allergies, children with food allergies are at increased risk of deficient nutritional
status because practitioners often prescribe allergen avoidance, leading to a forfeit of vital,
nutrient-dense foods, such as milk, in children’s diets (Groetch & Nowak-Wegrzyn, 2013).
A child’s diet proportionally requires more nutrients to ensure the child continues to grow
at a healthy rate (Groetch & Nowak-Wegrzyn, 2013).
Food allergies can be life-
threatening, especially for children with multiple food allergies who struggle to achieve
healthy nutritional status when avoiding nutrient-dense allergenic foods. Nutrition therapy
is a key intervention for caregivers to help children manage living with multiple food
allergies. Unfortunately, dietitians may lack sufficient resources to treat this target group
because of gaps in awareness and education in evidence-based treatment strategies to help
clients diagnosed with multiple food allergies.
Research conducted by Kapoor (2004) and Fleischer (2012) within the area of multiple
food allergies reveals increased risks of allergic attacks in children. This increased risk of
allergic attack was demonstrated in study of 62 children with food allergies, where 29
children with more than one food allergy composed 46% of the subjects but faced 93% of
the reactions recorded in the yearly follow-up (Kapoor et al., 2004). However, more
research is needed in this area to provide clear statistics on the rates of allergic reactions
and percentage of children facing multiple food allergies in the United States. Some studies
such as the Fleischer study (2012) have assessed the frequency of food allergies in
What’s Up Allergies 5
preschool children, who obtained avoidance advice. In a span of 36 months, 0.81 reactions
occurred per year (367/512 subjects reporting 1171 reactions [95% confidence interval:
0.76–0.85]). Most reactions (71.2%) were prompted by milk (495 [42.3%]), egg (246
[21.0%]), and peanut (93 [7.9%]), with chance exposures ascribed to accidental eating,
label-reading mistakes, and cross-contact (Fleischer et al., 2012). Based on this research
study, many children with food allergies undergo allergic attacks.
Dietitians are
professionals that could provide education and training that may lower risk of these attacks.
Considering the difficulties children with multiple allergies face, the lack of knowledge in
this subject area is troubling—especially for guardians seeking answers on how to feed
their children. Caregivers must be vigilant to avoid allergens when grocery shopping or
taking children out to eat, but the vigilance required to care for their children depends on
proper education. The ability to accurately read food ingredient labels and recognize
credible resources about food allergies and food alternatives is necessary for caregivers to
effectively protect the child. A study by Joshi and colleagues (2002) displayed that in a
group of caregivers for children with food allergies, identification of milk and soy protein
was the most problematic. Only four (7%) of 60 guardians correctly recognized the allergen
indicators for milk, and only six (22%) of 27 caregivers correctly identified soy protein. Of
those who were asked to identify peanut labels, 44 (54%) of 82 caregivers recognized the
label (Joshi, Mofidi, & Sicherer, 2002). In the previously discussed study by Fleischer and
colleagues (2012) assessing the frequency of allergic reactions to food in affected
preschool children, 113 (15.8%) of the 729 accidental exposures occurred due to labelreading errors.
What’s Up Allergies 6
Evaluation of nutritional status by a dietitian is critical for normal growth and development.
The nutritional status of children with multiple food allergies has been assessed in
independent research in France (Flammarion et al., 2011). In a cross-sectional study of 96
children (mean age 4.7 ± 2.5 years) with food allergies and 95 paired controls (mean age
4.7 ± 2.7 years) without food allergies, children with food allergies had lesser weight-forage and height-for-age Z scores than the control group (0.1 versus 0.6 and 0.2 versus 0.8
correspondingly). Children with three or more food allergies scored even lower for growth
than those with two or fewer food allergies (p = 0.04). Within in the same study, a total of
62 children with food allergies and 52 controls completed three-day diet records.
Analyzing the nutrient intake of the diet records revealed that energy, protein, calcium, and
vitamin (A, D, C, and E) intakes were comparable between the two groups (Flammarion et
al., 2011). Therefore, none of these nutrients explain why the children with food allergies
were smaller for their ages than the controls, even though they had similar nutrient intakes.
When the study was conducted, there were no available reference values for carbohydrate
and fat intakes, and fiber was not measured. (Flammarion, et al. 2011). The nutrient intakes
were evaluated by recommended nutritional intakes for healthy children in France, and
another study in the United States would help to address the question of whether children
with food allergies suffer growth deficits. More research into this area is clearly needed to
define normal and poor growth for children with multiple food allergies.
Children living with a food allergy must not only seek nutritious alternatives for excluded
foods, but must also watch for and ultimately accept the possibility of a life-threatening
What’s Up Allergies 7
allergic reaction from ingestion of an allergen. Common signs of an allergic event include
atopic dermatitis, dyspepsia (indigestion), urticaria (hives), wheezing, and anaphylaxis
(Garzon, 2011). Further, children with food allergies are two to four times more liable to
develop other conditions such as asthma and other allergies, compared to children without
food allergies (Branum & Lukacs, 2008). For every food allergy a child has, the challenges
they face are compounded, including meeting his or her nutritional needs.
Past research has confirmed that a childhood food allergy negatively affects general health
perception, caregiver emotion, and family activities--all of which are measures of quality
of life (Sicherer, Noone, & Muñoz-Furlong, 2001).
Individuals with multiple food
allergies (more than two) were more negatively affected than those with one or two
(Sicherer, et al., 2001). Although multiple food allergy occurrences negatively affect both
nutritional needs and health-related quality of life, most current research has been limited
to tree nut and peanut allergies, leaving the impact on quality of life from the full spectrum
of allergenic food types unexplored (Cummings, Knibb, King, & Lucas, 2010).
Easily accessible support and information would help caregivers better manage food
allergies in children. Regarding the guardians who scored perfectly in identifying the food
labels in the study by Joshi and colleagues, 90% belonged to the Food Allergy and
Anaphylaxis Network (Joshi et al., 2002). The Food Allergy and Anaphylaxis Network
(FAAN) was a large support organization that included patients and families affected by
food allergies along with health experts specialized in the field of food allergy
management. FAAN and its related agencies have reconsolidated into Food Allergy
What’s Up Allergies 8
Research and Education (FARE), which has a website (http://www.foodallergy.org/) with
resources available to guardians of children with food allergies.
The Web is becoming a more common source of information for food allergies among
caregivers and professionals. Organizations such as the American nonprofit think tank
Pew Research Center tracks Internet usage along with other trends that shape the United
States and the world; Pew Research numbers from 2006 reveal that eight out of ten people
who utilize the Internet did so for health information (Fox, 2006). The same report held
that 53% of the information sought influenced how Internet users cared for themselves or
others. However three-quarters of health inquirers did not regularly check who posted the
online information and when the information was last updated (Fox, 2006). However,
more recent data from the U.S. Dept of Commerce (2013) has shown that seven out of ten
homes had obtained broadband Internet by 2011 (U.S Dept of Commerce, 2013). The data
also showed that 42% of users roamed the Internet for self-prognosis or health management
activity (U.S. Dept of Commerce, 2013).
Consumers of health information need health professionals, including dietitians, who
specialize in multiple food allergies to help access the credibility of educational sources or
direct them to credible sources of information.
Currently, significant food allergy
knowledge gaps exist even among physicians, affecting the quality of life for patients with
food allergies and their families. Gupta and colleagues assessed these knowledge gaps
during many focus groups between physicians and patients (Gupta et al., 2008; Gupta et
al., 2009; Gupta et al., 2010). Within a sample of 407 physicians, 99% of the participants
What’s Up Allergies 9
administered treatment for patients with food allergies. Only 23% identified cheese and
yogurt from milk as dangerous for children with immunoglobulin E–mediated milk
allergies. Less than 30% of the respondents felt competent to read lab tests to spot food
allergies or amply skilled in their medical training to treat affected children (Gupta et al.,
2009). Another study published in 2008 also identified discomfort among physicians
regarding the diagnosis and management of food allergy (Yu, Kumar, Bruhn, Teuber, &
Sicherer, 2008). A study conducted in 2004 suggests that physicians who did not train on
a food allergy rotation during medical school are less likely to refer patients to allergists
(Baptist & Baldwin, 2004); however, this was the only article found on the subject of
patient referral for food allergies, so more research is necessary in this area to confirm this
conclusion. Consultations with general physicians provided caregivers less knowledge
than sessions with allergists, who have specific experience with administering elimination
diets and explaining how to use epinephrine injectors in the case of anaphylactic shock
(Gupta et al., 2010). In a different study, 28% of 82 physicians specified that they “never”,
“rarely” or “sometimes” referred patients to allergists following diagnosis of a food allergy
(Yu et al., 2008). More information is required to accurately estimate the rates of physician
referrals to allergists, but it appears that patient referral or the lack of it may be a significant
barrier to effective patient care. This suggests that education should be expanded beyond
the role of the pediatrician.
Although multidisciplinary clinics have been found to improve patient education more than
a single consultation with a physician (Kapoor et al., 2004), recent patient education
literature for food allergies focuses more on physicians and allergists than dietitians.
What’s Up Allergies 10
Physicians usually help diagnose and manage food allergies, but not all physicians view
food allergies as life threatening or view themselves as patient educators (Hu, Paed, Grbich,
& Kemp, 2008). In an Australian study (Hu et. all 2008), physicians with this view gave
basic allergen avoidance instruction but did not advise epinephrine injector use or
avoidance of food containing warnings of allergens on the package. This leads to
frustration for parents who tend to prefer more moderate, accessible approaches from
doctors (Gupta et al., 2010; Hu et al., 2008). Doctors within the study who viewed teaching
caregivers about food allergies as one of their duties tended to reside at clinics with greater
proportions of dietitians and nurses and were more inclined to refer families to them (Hu
et al., 2008). Guardian knowledge was shown to improve as a result of these referrals (Hu
et al., 2008). The impression given by the research is that clients prefer medical
professionals who are advocates for patient needs and education.
A multidisciplinary clinic may offer a balanced solution to addressing patient needs and
education pertaining to food allergies, allowing caregivers to seek information from
multiple sources at key intervals. Doctors within the Australian study (Hu et al., 2008) who
tended to have an extreme view of the risks of food allergy would act as patient educators
but would provide inflexible certainty about the risks and large amounts of information and
in one setting, which families found difficult to grasp (Hu et al., 2008). These results concur
with studies that developed informative materials about food allergies that a curriculum
should fit each stage of need (Hu, Grbich, & Kemp, 2007) (Vargas et al., 2011). One study
suggests that patient education could pair specific stages of food allergy treatment (e.g.
initial symptoms, diagnosis, and management) with child development (e.g infancy, early
What’s Up Allergies 11
childhood, and adolescence) (Vargas et al., 2011). This would address issues for parents
such as preventative measures against food allergies for at-risk infants, first diagnosis,
starting school, etc. (Vargas et al., 2011). In order to fully prevent allergic reactions, patient
education should cover issues pertinent to food allergies such as cross-contamination,
allergen avoidance, label reading, and epinephrine injector use (Venter et al., 2012;
Sicherer et al., 2012; Fleischer et al., 2012).
Although the role of a dietitian in the treatment of food allergies has proven beneficial, the
actual rates of referrals to dietitians in cases of food allergy are unknown (Venter et al.,
2012). Three well-known organizations have released guidelines for the diagnosis and
treatment of food allergies: The World Allergy Organization (Fiocchi et al., 2010), the
United States National Institute of Allergy and Infectious Disease (Boyce et al., 2010), and
the United Kingdom National Institute for Health and Clinical Excellence (Walsh &
O’Flynn, 2011). The World Allergy Organization (WAO) guidelines specifically refer to
the diagnosis of cow’s milk allergy and covers recommendations from when specialists
suspect an allergy to when they confirm an allergy with an oral food challenge (Fiocchi et
al., 2010). These WAO guidelines recognize the limitations of allergen avoidance, the
reintroduction of avoided foods, and food records-and thus cover skin prick tests, serum
milk-specific IgE, and oral food challenges as well (Fiocci et al, 2010). The United States
National Institute of Allergy and Infectious Disease (NIAID) guidelines (listed one through
43) are meant to provide succinct recommendations to a diverse audience of health care
professionals on food allergy diagnosis, food allergy management, and treatment of acute
reactions (Boyce et al., 2010). NIAID also pinpoints gaps in current scientific research
What’s Up Allergies 12
(such as the long-term effects of targeted food elimination diets) and aims to clear up issues
of recent debate in patient management (such as whether physicians should recommend
the egg-protein flu vaccine to patients with egg allergies) (Boyce et al. 2010). The UK
National Institute for Health and Clinical Excellence (NICE) Guidelines are outlined in a
much shorter document than the previous guidelines and focus specifically on food
allergies in children and other young people; as a result, the recommended health
professionals watch for signs of slowed growth and muscle wasting (Walsh & O’Flynn,
2011). NICE suggests that health professionals should collect an allergy-focused clinical
history if they suspect food allergies may be the cause of symptoms (such as constant
eczema or gastroesophageal reflux disease and bowel symptoms) that do not respond to
typical treatment (Walsh & O’Flynn, 2011). The guidelines also differentiate between
treatment of immunoglobulin E (IgE) mediated reactions (instant type 1 hypersensitivity
reactions) and non-IgE mediated reactions (reactions that occur several hours after allergen
contact) (Walsh & O’Flynn, 2011).
Each of the guidelines described above identify the major part nutrition education plays,
but only the UK guidelines recognized that dietitians participate in the detection and
managing of food allergies (Walsh & O’Flynn, 2011). As a result, the International
Network for Diet and Nutrition in Allergy (INDANA) (http://www.indanaallergynetwork.org/) formed to further the field of food allergy treatment for dietitians and
nutritionists on a global scale. INDANA advocates and distributes evidence-based practice
protocols for dietitians to help manage food allergies (Venter et al., 2012). Since then,
What’s Up Allergies 13
INDANA became integrated into the American Academy of Allergy, Asthma and
Immunology (AAAAI).
The lack of a dietitian’s role in food allergy management may be due to knowledge gaps
among pediatric dietitians in the United States. A sample size of 331 registered dietitians
that were active in the Pediatric Nutrition Practice Group of the American Dietetic
Association. rated themselves on a 4-point gauge of skill (“high,” “moderate,” “low,” and
"none"). Most rated themselves as moderate” for patient education, constructing meal
plans, and assessing food items to be allergen-free and “low” for crafting indicative food
challenges (Groetch, Christie, Vargas, Jones, & Sicherer, 2010). The majority of dietitians
who participated in this study were employed in ambulatory (46%) and inpatient (37%)
facilities, and 50% had more than 15 years of professional experience as registered
dietitians (Groetch et al., 2010). Most respondents educated themselves (75%) about food
allergies via professional publications and used hand-outs to educate clients (Groetch et
al., 2010). Despite this, less than 20% of those surveyed understood the following steps
involved in the diagnosis of food allergies: the oral food challenge, the elimination diet,
assessment of safe food items in a school or hospital setting, and intervening for
feeding/behavior problems caused by food allergies (Groetch et al., 2010). The result of
this study was the creation of food allergy patient curriculum by the Food Allergy
Consortium Group based on the dietitian’s needs (Groetch et al., 2010), but more research
is needed to explore the knowledge base on food allergies among dietitians.
What’s Up Allergies 14
Professor Wang, the Director of the UND Coordinated Program in Dietetics and a
Registered Dietitian, faced a situation similar to the dietitians in the study by Groetch and
colleagues (2010) as she tried to treat the multiple allergies of her granddaughter (personal
communication, June 4, 2013) . When the granddaughter had her first reaction to dairy,
physicians at the local hospital confirmed the granddaughter’s dairy allergy. Physicians
referred her to an allergist, but no referral to a dietitian was given. They had to seek dietetic
advice for food allergies on their own. Later, the granddaughter proved to be allergic to not
just dairy but nuts, shellfish, and eggs, and Professor Wang educated herself by collecting
materials from an information fair in Minnesota on food allergies. These materials became
the basis of research to better qualify the sources of information to help dietitians find
credible materials to educate their clients.
Methods
Education materials collected from the Food Allergy Support Group of Minnesota
Resource Fair in November 2012 were categorized from February through May, 2013.
These materials were collected at the fair by Doris Wang, Clinical Assistant Professor at
the University of North Dakota. The following categories were defined for educational
materials: allergy management resources, recipes, support groups/networks, non-food
products, consultants/educators (experts), allergy-free food, and grocery store/co-ops.
These categories were selected on the type of material given, most of which came in the
form of pamphlets or brochures. The categories and materials were listed on a Microsoft
Excel spreadsheet.
What’s Up Allergies 15
The following key terms were used to research the topic of multiple food allergies: food
allergy, allergen, food, sensitization, food hypersensitivity, patient education, self-care,
food hypersensitivity/diagnosis, food hypersensitivity/therapy, and dietitian. Scopus,
Pubmed, Academic Search Premiere, and CINAHL databases provided articles crossreferenced to these terms. Literature authors and organization association also helped to
identify experts within the field of food allergies.
The methods used to categorize the material included redefining and expanding the
selection of categories. As an active search produced experts behind each education piece,
the contact information of experts and defunct websites surfaced. Research in June and
July 2013 led to nationally known research institutes and organizations. Background
reading identified Consortium of Food Allergy Research (CoFAR) educational materials
that are free to download from the web at www.cofargroup.com, with a lesson plan to guide
caregivers through each phase of food allergy management including hand-outs for each
respective phase.
Guidebooks such The Health Professional Guide to Food Allergies and Intolerances also
proved instructional and focused on the science behind food allergy, elimination diets, and
foods allowed for children with multiple food allergies. Initially, the plan for the Resource
Guide included tables from this book. Upon request to reprint tables from her book, the
author Janice Vickerstaff Joneja, P.h.D., R.D. recommended hand-outs she had written and
had been copyrighted by the American Academy of Nutrition and Dietetics. These handouts covered individual allergies, intolerances, and special diets considerations. They also
What’s Up Allergies 16
included food records for adults, children, and breast-feeding mothers. The Resource
Guide includes the author of the Health Professional Guide to Food Allergies and
Intolerances on its list of experts, and she has a website called www.allergynutrition.com.
Dr. Vickerstaff Joneja is only the second practicing R.D. that was found with a website.
Not included in the inventory are the International Network for Diet and Nutrition in
Allergy guidelines outlining when a physician should refer clients to a dietitian, thus
expanding and clarifying the dietitian’s role in treating food allergies. These guidelines
were endorsed by the American Academy of Allergy, Asthma and Immunology and are
available with case studies at http://www.hindawi.com/journals/ja/2012/269376/.
Unlike INDANA guidelines, the specialty products and recipes and non-allergen foods are
regionally-based in the United States. Of the experts column, INDANA, the World Allergy
Organization, Food Allergy and Anaphylaxis Alliance were international. The doctors and
dietitians were regional (ex. Doctor Joneja in New York, Kristi Winkels in MN).
The
categorization and collection of educational materials resulted in the creation of the
Educational Resource Guide for Living With Multiple Allergies, which includes
spreadsheets indicating the catalogue of resources and categories clarifying their use.
What’s Up Allergies 17
Results
A trend noted was that educational material was often included in brochures selling a
specific product targeted toward those affected with allergies. Some of the more instructive
materials had input from experts in the field of allergy management such Doctor Michael
Pistiner, MD, from No Biggie Brunch (a children’s book series); The No Biggie Brunch is
included in the support group category. Thus the discovery of Doctor Pistiner led to the
creation of the experts category, which includes Kristi Winkels, a registered dietitian
specializing
in
allergies
in
Minnesota
with
a
website
called
www.eatingwithfoodallergies.com/ and larger institutions such the American Academy of
Asthma and Immunology. Table 1.1 shows a sample of these resources from the inventory.
On the other hand, the Food Allergy and Anaphylaxis Network (FAAN), a major support
organization behind some of the materials, had endorsed some of the materials but now is
defunct. In the last year, the FAAN joined with another organization called the Food
Allergy Initiative (FAI) to form Food Allergy Research and Education (FARE). Many of
the materials in the collection still utilize the FAAN or FAI label. To add to the
confusion, branches of the defunct website FAAN (now FARE) such as Food Allergies in
the Real World (FAANTeen.Org), FAAN organization, Be a PAL (Protect a Life),
FAAN College Network still exist —although the organization itself is now defunct.
What’s Up Allergies 18
Table 1.1 Types of Resources
Allergy
Manageme
nt
Resources
AllerDine
Allergic
Traveler
Allergy Eats
AllergyFree
Passport
Experts
Support
Groups/
Networks
Recipes
MN Grocery
Store/Co-Op
Non-Food
Products
Allergy-Free
Food
Abbott
Nutrition
Health
Institute
American
Academy of
Allergy
Asthma &
Immunology
American
College of
Allergy,
Asthma &
Immunology
Academy of
Nutrition
and Ditetics
Allergy Eats!
Blog
Eating With
Food
Allergies
Alert
Clothing
Company
Abbott
Nutrition
Elecare
Allergy Free
Mom.Com
Food Allergy
and
Anaphylaxis
News
(Defunct)
FoodAllergy
Books.Com
Dey Pharma,
L.P.
(Subsidary of
Mylan)
Fresh and
Natural
Foods
Allerbling
Wristbands
Amanda's
Own
Confections
Lakewinds
Natural
Foods
Allergic
Living
Magazine
CheeCha
Puffs
Mylan
Specialty L.P.
American
Medical ID
Bracelets
Daiya Foods
National
Cooperative
Grocers
Association
(Parent
organization
of Stronger
Together CoOp)
Awearables LLC
(Allermates)
Ener-G
Foods, Inc
BugaBees
LLC
Enjoy Life
Foods
Allermates.Com
Consortium
of Food
Allergy
Research
Eating With
Food Allergies.Com
Eating With
Food
Allergies
(Kristi
Winkels, RD)
Allergy Free
Table, LLC
Anaphylaxis
& Food
Allergy
Association
of
Minnesota
American
Academy of
Allergy
Asthma &
Immunology
American
College of
Allergy,
Asthma &
Immunology
Namaste
Foods
Recipes
What’s Up Allergies 19
As one explores the support groups in the inventory, more interconnections arise between
support groups and other organizations (ex. Stronger Together and National Cooperative
Grocers Association, Epi-Pen Pak and Center for Anaphylactic Support, which is now
defunct). It makes sense that people who sell the specialized products for food allergy
management would offer support to families experiencing the multiple food allergy
condition, but a division emerged in the type of support offered. One faction offered
educational materials from certified experts, while the other tended to include sellers of
allergen-free specialty products or guardians of patients with multiple allergies that offered
advice on feeding children.
Other nationally known research institutes and organizations had created pamphlets in the
collection such the American College of Allergy, Asthma & Immunology or the Allergy
or the Asthma Network Mothers of Asthmatics, who organize Allergy and Asthma Day at
the Capitol on May 9. Related to these organizations is the international World Allergy
Organization, which spreads the awareness of food allergies by holding World Allergy
Week (April 8-14). However, education components endorsed by experts were more of
the exception than the norm. Few materials in the collection also adequately explained food
allergy occurrences and management in an evidence-based approach. As a result, the
inventory contains other materials that may be useful to dietitians and may help relieve the
burden of self-education.
What’s Up Allergies 20
The materials that were not originally a part of the collection include the curriculum from
Consortium of Food Allergy Research (CoFAR), a group that includes allergy experts in
the field of nutrition. The CoFar hand-out on nutritional issues seemed vague and skeletal
in specific details—such as suggestions for milk substitutes in recipes or milk substitutes
for beverages (rice milk or potato-based beverages). Other hand-outs such as the one
entitled “Handling Food Allergies in the Home” were more detailed and specific. The
CoFAR materials were developed to serve patients across the U.S.; in contrast, the
Minnesota Resource Fair was regionally based and had many materials written by small
businesses to advertise specialty products for those affected by food allergies (e.g. recipe
books written by mothers experienced in cooking for children with allergies). The recipe
books connect to online support groups, which may be helpful for patients navigating food
allergy management. These materials could give insight into client needs/interests (e.g.
products related to special diets), but should not be used as the basis of care.
To help dietitians treat clients using an evidence-based approach, other materials approved
by organizations such American Academy of Nutrition and Dietetics (AND) were also
included. The hope is that creation of this guide will bridge existing knowledge gaps. Table
1.2 exhibits a sample of AND Materials, while Table 1.3 shows an example of the CoFAR
Materials, which were approved by the National Institute of Health.
What’s Up Allergies 21
Table 1.2 Academy of Nutrition and Dietetics Materials
Categories
Names of
Publications
Top 10
Allergens
"Milk Allergy"
Other
Allergens
"Yeast Mold
Allergy"
Intolerance/Se
nsitivity
"Lactose
Intolerance"
Special Diet
Considerations
"Casein-Free
Diet:A Trial
Diet for
Autism"
Food Records
"Adult Food
and Symptom
Record"
Table 1.3 Consortium of Food Allergy Research Materials
Categories
Names of
Publications
Introduction
Understanding
your child's
food allergy
Avoiding food
allergens
“Food Allergy
Basics for the
Newly
Diagnosed”
"Anaphylaxis
to Foods"
"How to Read
Labels to Avoid
Food
Allergens"
Managing
food allergy
inside and
outside of the
home
"Preparing
Allergen-Safe
Meals in the
Home"
Living a safe
and healthy
life with food
allergies
"Nutritional
Issues with
Food Allergy”
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
ABBREV.
NAME
ADDRESS
N/A
Abbott
Nutrition
Elecare
Abbott
webmaster@abbo (800) 227Nutrition
tt.com
5767
Consumer
Relations
625 Cleveland
Avenue
Columbus,
Ohio 432151724
www.abbot
tnutrition.c
om or
www.abbot
store.com
N/A
Alert Clothing
Company
5805 State
Bridge Rd
Suite G-121
Johns Creek,
GA 30097
alertclothing@bell N/A
south.net
http://ww
w.alertclot
hingcompa
ny.com/
N/A
Allergic Traveler 1812
Swannanoa
Dr,
Greensboro,
North
Carolina
27410
Allergy Eats
N/A
Pres. Tarah
(336)558Jakubiak
4268)
e:tarah@allergictr
aveler.net
www.allerg
ictraveler.n
et
N/A
EMAIL ADDRESS
N/A
contact@allergyea
ts.com
N/A
AllergyFree
Passport
N/A
AllergyFree
Same as
(Gluten Free)
above
Passport Mobile
App
TELEPHONE
WEBSITE
website:
www.allerg
yeats.com
27 North
info@glutenfreepa 312-952-4900 www.allerg
Wacker, Suite ssport.com
yfreepassp
258 Chicago,
ort.com;
IL 60606
glutenfreep
assport.co
m
Same as above
Same as above http://glute
nfreepassp
ort.com/all
ergy-glutenfree-apps/
(Apple
iStore)
What's Up Allergies 22
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
Allerbling
Wristbands
N/A
N/A
Allergic Living
Magazine
P.O. Box 1042 info@allergicliving. (888) 771Niagara Falls, com
7747
NY
14304
AANMA
Allergy and
Asthma
Network
Mothers of
Asmathics
8201
N/A
Greensboro
Drive, Suite
300 McLean,
VA 22102
N/A
Amanda's Own Amanda's
Confections
Own
Confections,
Westlake,
Ohio 44145
American
555 East
Academy of
Wells Street
Allergy Asthma Suite 1100
& Immunology Milwaukee,
WI 532023823
AAAAI
AND
ACAAI
APFED
[email protected] N/A
om
http://ww
w.allerbling
.com/
http://ww
w.allergicliv
ing.com/
800-878-4403 http://ww
w.aanma.or
g/
admin@amandaso 440-331-3998 http://ww
wn.com
w.amandas
own.com/
[email protected]
(414) 2726071
www.aaaai.
org
American
Academy of
Nutrition and
Dietetics
120 South
knowledge@eatrig Phone:
www.eatrig
Riverside
ht.org
800/877-1600 ht.org
Plaza, Suite
Phone:
2000
312/899/0040
Chicago,
Illinois 606066995
American
85 West
[email protected]
(847) 427www.acaai.
College of
Algonquin
1200
org/
Allergy, Asthma Road, Suite
& Immunology 550
Arlington
Heights, IL
60005
American
[email protected]
713-493-7749 www.apfed
Partnership for PO Box 29545
.org
Eosinophilic
Atlanta, GA
Disorders
30359
What's Up Allergies 23
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
AAFA
Asthma and
Allergy
Foundation of
America
8201
[email protected]
Corporate
Drive
Suite 1000
Landover, MD
20785
N/A
BugaBees LLC
6907
amy@thebugabee N/A
University
s.com
Avenue #265,
Middleton,
Wisconsin
53562
http://ww
w.thebugab
ees.com/
N/A
CheeCha Puffs
N/A
[email protected] 1-877-243a
3242
CoFAR
Consortium of
Food Allergy
Research
N/A
webmaster:
scushing@emmes.
com or info for
CoFAR study
[email protected]
m.
Daiya Foods
N/A
Leave comments
at
http://www.daiyaf
oods.com/contactus
Dey Pharma
110 Allen
Leave comments
Licensed
Road
at
Pharmaceuticals 4th Floor
http://www.mylan
(Subsidary of
Basking Ridge, specialty.com/cont
Mylan)
NJ 07920
act_us.aspx
(301) 2511161
http://ww
w.cheecha.
ca/
www.cofar
group.com
N/A
Eating With
N/A
Food
Allergies.Com
(Kristi Winkels,
RD)
651-249-9004 http://ww
w.eatingwit
hfoodallerg
ies.com/co
ntact.html
N/A
Ener-G Foods,
Inc
N/A
N/A
N/A
5960 1st AVE 1-800-331-5222
S
Seattle,
Washington
98108
1-800-7278462
NA
www.aafa.
org
http://ww
w.daiyafoo
ds.com/
(908) 542-1999 www.myla
nspeciality.
com
customerservic website:
[email protected] http://ww
w.energ.com/
What's Up Allergies 24
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
Enjoy Life Foods 3810 N. River info@enjoylifefoo (888) 503Road
ds.com
6569
Schiller
Park, Illinois
60176
N/A
Enjoy Life Foods Same as
Survival Guide above
N/A
N/A
Same as above http://ww
w.enjoylifef
oods.com/s
urvivalguid
e/
Enzymedica
Enzymedica, Leave comments 888-918-1118 http://ww
Enzyme Exports Inc. Attn:
at
w.enzymed
Returns Dept. http://www.enzym
ica.com/
771
edica.com/contactCommerce
us.html
Dr. Venice, FL
34292
Epi-Pen 2 Pak
110 Allen
N/A
(908) 542http://ww
Road
1999 (Main
w.epipen.c
4th Floor
Phone)
om/
Basking Ridge,
NJ 07920
N/A
Fergus Foods,
LLC (Nots)
FAAA
Food Allergy
N/A
and Anaphylaxis
Alliance
Same as above
Rob Fuglie
Fergus Foods, LLC 612-201-3809 http://ww
(Few-glee) or PO Box 374
w.notswebsite:
Fergus Falls, MN
snacks.com
56538
/
webmaster@food N/A
allergyalliance.org
FAAN News Food Allergy
Same as FARE Same as FARE
and Anaphylaxis
News (Now Fare
Newsletter)
FAAN
www.enjoy
lifefoods.co
m/
Food Allergy
Same as FARE Same as FARE
and Anaphylaxis
Network (Now
http://ww
w.foodaller
gyalliance.o
rg/
Same as FARE http://ww
w.foodaller
gy.org/stayinformed/n
ewsletters?
Same as FARE Same as
FARE
What's Up Allergies 25
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
FAAN PAL
FAAN Be a PAL
(Protect a Life)
Same as FARE Same as FARE
(800) 9294040
FAAN Teen Food Allergies
in the Real
World
FARE
Food Allergy
Research &
Education
Same as FARE Same as FARE
(800) 9294040
N/A
N/A
FASGMN
FPIES
http://ww
w.fankids.o
rg/
FAAN College
Same as FARE Same as FARE
(800) 929http://ww
Network
4040
w.faancolle
genetwork.
org/
FoodAllergyBoo Linda Coss
Linda@FoodAllerg 949-699-2749 http://ww
ks.Com (Books Plumtree
yBooks.com
w.foodaller
by Lina Cross) Press
gybooks.co
Plumtree Press P.O. Box 1313
m/author.h
Lake Forest,
tm
CA 926091313
USA
7925 Jones
Branch Dr.,
Suite 1100,
McLean, VA
22102
Food Allergy
9804
Support
Evergreen
Network of
Circle North
Minnesota
Brooklyn
Buddy Program Park, MN
of
55443
Food Protein- PO Box 304
Induced
Stewartville,
Enerocolitis
MN 55976
Syndrome
Foundation
http://ww
w.faanteen.
org/
contactfare@food Toll-Free: 800- http://ww
allergy.org
929-4040
w.foodaller
Main: 703-691- gy.org/
3179
info@foodallergys N/A
upportmn.org
http://ww
w.foodaller
gysupport
mn.org/
(507)-358http://fpies
contact@thefpiesf 7598 to
foundation.
oundation.org
contact
org/
Executive Chair
Joyce Meyer
What's Up Allergies 26
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
Fresh and
Natural Foods
Grocery Store
N/A
A Gift of Miles
(Life-Coach
Kristin Beltaos,
M.A.)
Gimbal's Fine
250 Hillside
Candies
Blvd. S. San
Francisco, CA
94080
Happy Family
40 Fulton St.
Brands
17th FL New
York, NY
10038
N/A
N/A
Plaza 94
Shopping
Center
1701 Ward
Avenue, Ste
200,
Hudson, WI
54016 or
Shoreview
Village Mall
1075 West
Highway 96,
Shoreview,
MN 55126
Minneapolis,
MN
Leave comments
at
http://www.fresha
ndnaturalfoods.co
m/contact-us/
Hudson, WI
phone 715377-9913 or
Shoreview, MN
- 651-2033663
http://ww
w.freshand
naturalfood
s.com/
kristin@agiftofmile (612) 845s.com
7585
http://ww
w.agiftofmi
les.com/
[email protected] (866) 9726879
gimbalscan
dy.com
parents@happyfa (212) 374milybrands.com
2779
http://happ
yfamilybran
ds.com/
N/A
HomeFree
Treats
N/A
Huey's Nut Free N/A
Chocolate
kristen@hueysnutf 612-801-4473 http://ww
reechocolate.com
w.hueysnut
freechocola
te.com/
INDANA
International
Network for
Diet and
Nutrition in
International
Association for
Food Protein
Enterocolitis
info@indanaN/A
allergynetwork.org
IAFFPE
P.O. Box 491 info@homefreetea or toll-free 800- http://ww
Windham, NH ts.com
552-7172 or
w.homefre
03087-0491
phone Phone: etreats.co
603-898-0172 m/
N/A
2372
[email protected] N/A
Highway 9
rg
South,
Howell, New
Jersey 07731
http://ww
w.indanaallergynetw
ork.org/
http://ww
w.iaffpe.or
g
What's Up Allergies 27
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
Jovial Einkorn or Jovial Foods,
Gluten Free
Inc.
Cookies
5 Tyler Drive
North
Franklin, CT
06254
[email protected] 877-642-0644 http://ww
om
w.jovialfoo
ds.com/
KFA
Kids With Food
Allergies
Foundation
(Part of AAFA)
5049 Swamp
Rd, Ste 303,
PO Box 554,
Fountainville,
PA 18923
https://www.kids (215) 230withfoodallergies.o 5394
rg/email.php?to=in
fo;
N/A
Kinnikinnick
Foods, Inc
10940-120 St info@kinnikinnick. Toll Free: 1www.kinnik
Edmonton,
com
877-503-4466 innick.com
Alberta
or Local: 780Canada T5H
424-2900
3P7
N/A
Lakewinds
Natural Foods
Grocery Store
N/A
MedicAlert
Foundation
N/A
Medbags
(Embroidered
medication
Medical ID
Marketplace
435 Pond
Promenade
Chanhassen,
MN 55317
or
17501
Minnetonka
Blvd
Minnetonka,
MN 55345
2323
Colorado
Avenue
Turlock, CA
95382
N/A
N/A
Leave comments
at
http://www.lakewi
nds.coop/contactus/generalinquiries/
http://com
munity.kids
withfoodall
ergies.org/
Chanhassen
http://ww
Store: 952-697- w.lakewind
3366 or
s.coop/
Minnetonka
Store: 952-4730292
privacy@medicaler 1-888-633t.org.
4298
http://ww
w.medicale
rt.org/
N/A
Kim Gowdy at www.medb
612-0325-7020 ags.net
(defunct)
100 Front
hopepaige@hopep 1(877)651www.MedStreet Suite aige.com
5186 or (610) bracelet.co
300
234-0093
m or
West
https://ww
Conshohocke
w.hopepaig
n, Pa 19085
e.com/
What's Up Allergies 28
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
MedPax
N/A
[email protected] N/A
om
FEEDS
Minnesota
N/A
FPIES-EoE-EGIDs
Disease Support
[email protected] N/A
g
N/A
Mylan Specialty 1500
Licensed
Corporate
Pharmaceuticals Drive
Canonsburg,
Pa. 15317
Contact us at
http://www.mylan
.com/~/link.aspx?_
id=0784BA1357C8
45D9B40BD2B027
51D495&_z=z
N/A
Namaste Foods, P.O. Box 3133
LLC
Coeur
d'Alene, ID
83816
Namaste Foods Same as
Recipes
above
National
National
Cooperative
Cooperative
Grocers
Grocers
Association
Association,
(Parent
14 S Linn
organization of Street, Iowa
Stronger
City, Iowa
Together Co52240
National
55 Kenosia
Organization for Avenue
Rare Disorders Danbury, CT
06810
admin@namastefo Toll Free 1-866- www.nama
ods.com
258-9493
stefoods.co
m
N/A
NCGA
NORE
N/A
No Biggie Bunch
Children's Book
Series
(Endorsed by
Michael
Pistiner, MD,
MMSc
P.O. Box
95024
Newton, MA
02495
(908) 5421999 (Main
Phone) or
customer
relations (800)
395-3376
(Main Phone)
http://ww
w.mymedp
ax.com/
https://ww
w.facebook
.com/MNFE
EDS
http://ww
w.mylansp
ecialty.com
/
Same as above
Same as above Same as
above
Leave comments (866) 709https://ww
at
COOP
w.ncga.coo
https://www.ncga.
p/
coop/contact/gene
ral
http://www.raredi Phone:(203)
www.raredi
seases.org/about/c 744-0100 or
seases.org
ontact-us
Toll Free: (800)
999-6673
(voicemail
only)
N/A
info@nobiggiebun
ch.com
http://ww
w.nobiggie
bunch.com
/
What's Up Allergies 29
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
NxtNutrio
Mobile App
1500
McAndrews
Road W
Suite 245
Minneapolis
MN 55337
2901 S
Bayshore
Drive, Miami,
Florida
N/A
http://ww
w.nxtnutrio
.com/
(Apple
iStore)
[email protected] N/A
m
http://ww
w.omaxcar
e.com/
[email protected]
m
N/A
OmaxCare
N/A
One Dish at a
Time (Tracy KS
Yue, Dietetic
Tech. degree,
cooking coach
Peanut Free
Planet
Saint Paul,
Minnesota
N/A
Safety Sticker
Store
N/A
info@safetysticker N/A
store.com
N/A
Sophie Safe, LLC N/A
Emily Hendrix
N/A
(author of grocery
guide and recipe
books) email:
sophiesafe@gmail.
com
N/A
SoyNut Butter
Company
800-288-1012
info@soynutb http://ww
utter.com
w.soynutbu
tter.com/
888-636-4221
info@spangler http://ww
candy.com
w.spanglerc
andy.com/
1-800-437-5539
info@sunbutte http://ww
r.com
w.sunbutte
r.com
N/A
N/A
N/A
onedishatatime@ 612-770-4488 website:
me.com;
http://oned
tracyksyue@yahoo
ish.wordpr
.com
ess.com/
15252 Stony 317-219-3795
Creek Way
Suite 103
Noblesville, IN
46060-4390
4220
Commercial
Way
Glenview, IL
60025
Splangler Candy 400 N.
Company
Portland St.
PO Box 71
Bryan, OH
43506
Sunbutter
42nd St. N.
Fargo ND,
58102
info@peanutfr www.pean
eeplanet.com utfreeplane
t.com
www.safet
ystickerstor
e.com
http://ww
w.sophiesaf
e.com/
What's Up Allergies 30
Resource Guide for Living with Multiple Food Allergies
Complete Catalogue of Resources
N/A
SunWise Foods 225 East Main 218-346-6428
Street,
Perham, MN
56573
N/A
Surf Sweets
N/A
Vermont Nut
10 Island
customerservice@ 1-888-468-8373 http://ww
or 802-372-4654
Free Chocolates Circle Grand vermontnutfree.co
w.vermont
Isle, VT 05458 m
nutfree.co
m/
Vickerstaff
Address: 2016 vickerstaffhs@aller Phone: 250www.allerg
Health Services High Canada gynutrition.com
377-0945
ynutrition.c
(Janice M.
Place,
om
Joneja, Ph.D.,
Kamloops,
RD)
B.C. V2E 2E3
Canada
Phone: 250377-0945
N/A
info@sunwisef www.sunwi
oods.com
sefoods.co
m
TruSweets,
[email protected] (224) 676-1070 http://ww
LLC
om
w.surfswee
648 Wheeling
ts.com/
Road
Wheeling, IL
60090
N/A
WOWBUTTER
Foods
Hilton Whole [email protected]
(519) 345-0111 http://ww
Grain Millers
w.wowbutt
Ltd.
er.com
O/A
WOWBUTTER
Foods
Staffa,
Ontario,
Canada
WAO
World Allergy
Organization
555 East
info@worldallergy. (414) 276Wells Street org
1791
Suite 1100
Milwaukee,
Wisconsin WI
53202-3823
U.S.A.
http://ww
w.worldalle
rgy.org/
What's Up Allergies 31
Types of Resources
Allergy
Experts
Management
Resources
AllerDine
Abbott
Nutrition
Health
Institute
Allergic
American
Traveler
Academy
of Allergy
Asthma &
Immunolo
gy
Allergy Eats
American
College of
Allergy,
Asthma &
Immunolo
gy
Resource Guide for Living With Multiple Food Allergies
Support
Recipes
MN Grocery
Non-Food AllergyGroups/
Store/Co-Op
Products
Free Food
Networks
Allergy Eats! Eating
Dey Pharma, L.P.
Alert
Abbott
Blog
With Food
(Subsidary of
Clothing
Nutrition
Allergies
Mylan)
Company
Elecare
Allergy Free
Food
Fresh and Natural Allerbling Amanda's
Mom.Com Allergy and
Foods
Wristbands
Own
Anaphylaxi
Confection
s News
s
(Defunct)
Allergy Free FoodAllerg
Table, LLC yBooks.Co
m
AllergyFree
Passport
Academy Anaphylaxis Namaste
of
& Food
Foods
Nutrition
Allergy
Recipes
and
Association
Ditetics
of
Minnesota
Allermates.Co Consortiu American
m
m of Food Academy of
Allergy
Allergy
Research Asthma &
Immunology
Eating With
Eating
American
Food
With Food College of
Allergies.Com Allergies
Allergy,
(Kristi
Asthma &
Winkels, Immunology
RD)
Lakewinds
Natural Foods
Allergic
Living
Magazine
CheeCha
Puffs
Mylan Specialty
L.P.
American
Medical ID
Bracelets
Daiya
Foods
National
Awearables
Ener-G
Cooperative
LLC
Foods, Inc
Grocers
(Allermates)
Association
(Parent
organization of
Stronger
Together Co-Op)
BugaBees
LLC
Enjoy Life
Foods
What's Up Allergies 32
Types of Resources
Enjoy Life
Food
American
Foods Survival Allergy and Partnership
Guide
Anaphylaxi
for
s Alliance Eosinophilic
Medical
Disorders
Advisory
Board
Sophie Safe,
LLC
The Health
Professional's
Guide to Food
Allergies and
Intolerances
(Book)
FARE
Medical
Advisory
Board
Allergy and
Asthma
Network
Mothers of
Asmathics
FARE
Asthma and
Research
Allergy
Advisory Foundation
Board
of America
Resource Guide for Living With Multiple Food Allergies
Enzymedica
Fergus
Enzyme
Foods, LLC
Exports
(Nots)
Gluten Free
Passport
Mobile App
Happy
Family
Brands
Epi-Pen 2
Pak
Gimbal's
Fine
Candies
A Gift of
Buddy
Miles (Life- Program of
Coach Food Allergy
Kristin
Support
Beltaos,
Network
M.A.)
(MN)
Medbags HomeFree
(Embroidere Treats
d
medication
bags)
Internatio Center for
nal
Anaphylactic
Network
Support
for Diet
(defunct)
and
Nutrition
in Allergy
No Biggie Food Allergy
Bunch
and
(Michael Anaphylaxis
Pistiner,
Alliance
MD,
MMSc)
Medical ID Huey's Nut
Marketplace
Free
Chocolate
MedPax
Jovial
Einkorn or
Gluten Free
Cookies
What's Up Allergies 33
Types of Resources
Resource Guide for Living With Multiple Food Allergies
One Dish Food Allergy
at a Time
and
(Tracy KS Anaphylaxis
Yue,
Network
Dietetic (Now FARE)
Tech.
degree,
cooking
coach and
nutrition
educator)
NxtNutrio Kinnikinnic
Mobile App k Foods,
Inc
Vickerstaff FAAN Be a
Health PAL (Protect
Services
a Life)
(Janice
Joneja,
PhD, RD)
World
FAAN
Allergy
College
Organizati Network
on
Food Allergy
Initiative
(Now FARE)
OmaxCare
Namaste
Foods, LLC
Plumtree
Press
Peanut
Free Planet
Safety
Sticker Store
SoyNut
Butter
Company
Food
Allergies in
the Real
World
Splangler
Candy
Company
Food Allergy
Research &
Education
(FARE)
Sunbutter
Food
ProteinInduced
Enerocolitis
Syndrome
Foundation
(FPIES)
SunWise
Foods
What's Up Allergies 34
Types of Resources
Resource Guide for Living With Multiple Food Allergies
Internationa
l Association
for Food
Protein
Enterocolitis
(IAFFPE)
Surf Sweets
Kids With
Food
Allergies
Foundation
(Part of
AAFA)
MedicAlert
Foundation
Vermont
Nut Free
Chocolates
Minnesota
FPIES-EoEEGIDs
Disease
Support
National
Organization
for Rare
Disorders
No Biggie
Bunch Books
and website
WOWBUTT
ER Foods
Wildtree
Stronger
Together CoOp
Surf Sweets
Blog
What's Up Allergies 35
Academy of Nutrition
and Dietetics Materials
Resource Guide for Living With Multiple Food Allergies
Categories
Column1
Top 10
Other
Intolerance/ Special Diet
Allergens Allergens Sensitivity Considerations
Food Records
Name of
Publication
"Milk
Allergy"
"Yeast
Mold
Allergy"
"Lactose
"Casein-Free
Intolerance" Diet:
A Trial Diet for
Autism"
"Adult
Food and Symptom
Record"
"Wheat
Allergy"
"Nickel
Allergy"
"Sulfite
Sensitivity"
"Child
Food and Symptom
Record"
"Oral Allergy
Syndrome"
"Egg
Allergy"
"Disaccharid "Eczema and
e
Diet"
Intolerance"
"Soy
Allergy"
"Fructose
"Dietary
Intolerance" Management of
Hyperactivity in
Children"
"Tree Nut
Allergy"
"Benzoate "Introducing
Intolerance" Solid Foods to
the Potentially
Allergenic Baby"
"Fish
Allergy"
"Salicylate
Sensitivity"
"Shellfish
Allergy"
"Histamine
Sensitivity"
"Peanut
Allergy"
"Tyramine
Sensitivity"
"Corn
Allergy"
"HistamineTyramine
Restricted
Diet"
"Food and Symptom
Record
for a Breastfeeding Mother
and Her Baby"
(Available in hard copy)
What's Up Allergies 36
Academy of Nutrition
and Dietetics Materials
"Sesame
Seed
Allergy"
"The Top
Ten
Allergens"
Resource Guide for Living With Multiple Food Allergies
Categories
"Monosodium
Glutamate
(MSG)
Sensitivity"
"Food Dye
Sensitivity"
"Intolerance
of
Butylated
Hydroxyanis
ole
(BHA) and
Butylated
Hydroxytolu
ene (BHT)"
"Nitrate and
Nitrite
Intolerance"
(Available in hard copy)
What's Up Allergies 37
Resource Guide for Living With Multiple Food Allergies
Consortium of
Food Allergy Research Materials
Column1
Orientation
to Food
Allergies
Managing
Food Allergy
Inside and
Outside of
the Home
Name of
“Food Allergy "Anaphylaxis to "How to
"Preparing
Publication Basics for the Foods"
Read Labels Allergen-Safe
Newly
to Avoid
Meals in the
Diagnosed”
Food
Home"
Allergens"
"Parent’s
Check List
for Managing
Food
Allergies"
Understanding
Your Child's
Food Allergy
Avoiding
Food
Allergens
Living a Safe and
Healthy Life with
Food Allergies
"Nutritional Issues
for Food Allergy"
"Procolitis:
"Egg
"Restaurants "Introducing Foods
(Bloody Stools in Avoidance" and Food
for Infants and
Infants Caused
Allergy"
Young Children
by Food
with Food
Allergy)"
Allergies"
"Managing "Food Protein
Food Allergy" Enterocolitis
Video
Syndrome
(FPIES)"
"Milk
"Going to
Avoidance" School with
Food
Allergies"
"Eosinophilic
"Peanut
"Child Care
Esophagitis/
Avoidance" and Food
Eosinophilic
Allergies"
gastroenteritis"
"Dietary
Approaches to
Prevent or Delay
Allergy
for Infants at Risk"
"Living With Food
Allergies"
"Tree Nuts "Summer
Avoidance" Camp and
Food
Allergies"
"Soy
"Avoiding
Avoidance" Cross Contact
with Food
Allergens"
"Wheat
Avoidance"
"Fish
Avoidance"
"Shellfish
Avoidance"
"Sesame
Avoidance"
(Available in hard copy or electronic form)
What's Up Allergies 38
What’s Up Allergies 39
Discussion
The collection of focus groups conducted by Gupta and colleagues acknowledged the
knowledge gaps among primary care physicians regarding food allergies and
dissatisfaction among guardians with regard to this lack of knowledge across medical
disciplines related to managing food allergies. The first step to resolving this issue is that
clinicians such as dietitians must educate themselves and disseminate educational
resources for food allergy treatment across and among professional disciplines.
According to the findings of this project, patient education resources in the food allergy
realm have expanded in recent years, and organizations such as the International Network
of Nutrition and Dietetics in Allergy and American Academy of Nutrition and Dietetics
are working towards making resources for dietitians more available. The dissemination
of more credible educational materials will be possible if future projects are undertaken
that are similar to the current study which produced an educational resource guide.
The dissemination of educational materials will improve patient management and reduce
the frustration and difficulties expressed by the caregivers in the Gupta focus groups—
where an issue specified was punctual food allergy diagnosis and management advice
(Gupta et al., 2008). These same caregivers identified lack of physician knowledge on
food allergy as the cause. This is reflected in the caregivers’ lack of knowledge pertaining
to food allergen detection and risk in different settings and their views of food allergy
liability and incidence (Gupta et. al, 2010).
As a result, the quality of life for families
with children affected by food allergy diminishes.
What’s Up Allergies 40
Evidence suggests that physicians are aware of these gaps and are interested in further
education concerning referral guidelines, and patient education (Yu et. al, 2008). This
inspires hope that the role of dietitians in managing food allergy will continue to expand.
Timely diagnosis and suitable management of food allergies permit optimal quality of life
and nutritional status for a patient (Venter et. al, 2012). A diet history drawn up by an
allergy-specialist dietitian may guide the physician to further examination. To ensure that
the patient maintains adequate energy levels and nutrient intake, dietetic expertise
supporting the final diagnosis is vital. This also creates patient-centered counseling
(Venter et al., 2012).
Dietitians should consider the special challenge of providing patient education for
individuals with multiple allergies. Independent recommendations for dietitians treating
multiple allergies have been published (Venter et al., 2012) (Heyes, 2011). Registered
dietitian Tiffani Hayes recommends that any food with a dubious diagnosis should be
retested or challenged (Hayes, 2011). As allergen avoidance remains the standard advice
for managing food allergies, Hayes advises dietitians to educate patients and their
families about allergen avoidance and to also plan for the reinstatement of foods during
follow-ups. Dietitians must also keep in mind the risks associated with food allergen
avoidance.
Although elimination diets relieve chronic symptoms such as atopic
dermatitis when used to avoid proven food allergens, patients may undergo an acute
reaction upon reinstitution or accidental consumption of food allergens after longstanding avoidance; as a result, dietitians should not recommend food avoidance to treat
What’s Up Allergies 41
chronic symptoms such as atopic dermatitis or eosinophilic esophagitis when a food
allergy has not been officially diagnosed (Groetch & Nowak-Wegrzyn, 2013).
Finally, educators need to view the process of food allergy instruction as a way to give
caregivers pertinent information at critical stages, such as the introduction to food allergy
to an allergy management plan for pre-school or school.
In the study conducted by
Vargas and colleagues (2011), a single page “road map” of knowledge and abilities was
determined essential to effectively treat food allergy. This road map included categories
of food allergy knowledge such as symptoms, management, self-injectable epinephrine
usage, allergen avoidance, food label literacy, cross-contamination, and supervision of
allergies away from home (Vargas et al., 2011)
As food allergy rates continue to climb, the need for patient education regarding food
allergy will increase as well. The Consortium for Food Allergy Research addressed this
need through the creation of educational materials based on the roadmap idea developed
through focus groups of caregivers and by expert review; caregivers found the materials
insightful and were satisfied with the results (Sicherer et al., 2012). Such materials would
help caregivers whose children continue to experience a reaction, despite being aware of
food allergies and obtaining standard allergen avoidance advice. Such cases have
occurred in the 2012 study conducted by Fleischer and colleagues, which examined food
allergy occurrences in preschool children. Although participants received instruction on
standardized milk, egg, and peanut avoidance, 72% of them encountered reactions
(Fleischer et al., 2012).
What’s Up Allergies 42
The area of food allergy seems to be one in which physicians, dietitians, and clients alike
need wider instruction, and steps have been taken to bridge knowledge gaps. These gaps
are more prevalent in specialized areas such as multiple food allergies, as Professor Wang
discovered when locating resources to treat her granddaughter. She found one practicing
dietitian within in the Minneapolis area who would perform an elimination diet on
children younger than five. This brings into question whether lack of expertise pertaining
to food allergies exists in smaller states, such North Dakota, South Dakota and the rest of
the upper Midwest—though more research is needed to thoroughly explore this issue.
This resource guide is a start to bridging those knowledge gaps in my home state of North
Dakota, and hopefully in the future it can be expanded as more resources become
available. In order for this Resource Guide for Living with Multiple Food Allergies to
be used as intended, the information must reach the people who need it most. The
findings of this study will be condensed and submitted to the Journal of the Academy of
Nutrition and Dietetics as a commentary, a scholarly paper that addresses matters of
developing import and interest for the dietetics profession. This results of this study may
also be presented at the North Dakota Academy of Nutrition and Academy Annual
Meeting in Fargo, ND and and the Food Nutrition Conference Expo in Atlanta, GA in
2014. In the future, the Resource Guide for Living with Multiple Food Allergies can be
reformatted into a pamphlet for patient education purposes.
What’s Up Allergies 43
The optimal outcome for most patients occurs when clinicians practice coordination of
care. If coordination of care occurs in food allergy treatment, the resource developed
through this project may be happily rendered useless. The future looks bright for families
struggling to substitute nutrient-dense foods for children with multiple food allergies, as
steps are taken to improve the patient education process and the role of the dietitian
continues to develop. When practitioners in different medical fields work together to
diagnose and manage food allergy properly, the best treatment for patients will become
possible.
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