NUTRITION THERAPY FOR FOOD ALLERGIES AND SKIN DISEASES

DISORDER/DISEASES Food Allergies

NUTRITIONAL ACUITY Level 1 -2

DEFINITION OF TERMS Adverse Reaction to Food - a clinically abnormal response believed to be due to an
ingested food or food additive
Antibodies - proteins in the bloodstream or other body fluids are that produced in
response to foreign materials that enter the body
Anaphylaxis - a severe systemic allergic reaction that is potentially fatal
Food sensitivity - a general term for an adverse reaction to an ingested food or food
additive. Types of food sensitivity:
● Food hypersensitivity - an immunological hypersensitivity or truly allergic
reaction resulting from the ingestion of a food or food additive
● Food allergy - another term for hypersensitivity, but frequently misused to apply
to any adverse reaction to food, involves the immune system of the body. An
allergen, usually a protein in a food or ingredient causes an allergic reaction to a
person’s immune system to overreact
● Food idiosyncrasy - a quantitatively abnormal response to a food or food
additive. Such response differs from its physiologic or pharmacologic effect and
resembles a hypersensitivity reaction, but there is no immune mechanism
involved
● Food intolerance - a physiologic response to an ingested food or food additive
that is not immunologic in nature. This category includes idiosyncratic,
pharmacologic metabolic, or toxic reactions. It tends to come and go in severity
and is rarely life-threatening.
● Food toxicity - a general term for an adverse reaction after ingestion of a food
or food additive as a result of a non-immune reaction

DESCRIPTION An abnormal immunologic response to harmless food proteins, including

Immunoglobulin E (IgE)-mediated and non-IgE mediated allergic response.

Non-IgE mediated allergies have a slow onset and usually involve the GIT, while
IgE-mediated food allergies are characterized by an immediate onset of symptoms
BACKGROUND ● Food allergies are mediated through the immune system and can be classified
as IgE-mediated, non-IgE-mediated, or mixed IgE/non-IgE-mediated
● IgE-mediated reactions are characterized by stereotypical signs and symptoms
that develop usually within 60 minutes of ingestion
● The commonest foods implicated in IgE-mediated allergy are peanut, tree nuts,
shellfish, fish, milk, egg, wheat, soy, and sesame
● Mild to moderate allergic reactions may involve only skin and/or gastrointestinal
symptoms
● Anaphylaxis is any acute onset of respiratory and/or cardiovascular symptoms,
even if skin symptoms are not present, and may be life threatening
● Children with IgE-mediated food allergy frequently have other atopic disease,
such as asthma, eczema and allergic rhinitis
● Allergy testing is not necessary and is not indicated for suspected non
IgE-mediated food allergies, eg non-IgE cow-milk allergy and FPIES (see
flowchart below)

● Non-IgE-mediated food allergies are characterized by a delayed onset of signs

and symptoms, usually over hours to days following ingestion
○ The exception is FPIES (Food Protein Induced Enterocolitis Syndrome),
which occurs on average 2-4 hours after ingestion of the offending
allergen
● Non-IgE food allergies are common in the first 1-2 years of life, with most
resolving by early childhood
● They commonly involve the gastrointestinal tract
● Non-IgE-mediated allergies do not cause anaphylaxis and therefore are not
treated with adrenaline
● CMPI (Cow’s Milk Protein Intolerance) is an umbrella term still used by many
clinicians, which encompasses the non-IgE-mediated allergic conditions Food
Protein-Induced Allergic Proctocolitis and Food Protein-Induced Enteropathy
SYMPTOMS ● Dermatologic - hives which are raised, itchy, with raised welts on the body;
patches of dry, itchy, bumpy or scaly rashes called eczema on various parts of
the body like the elbow, knees, pruritus, atopic dermatitis and urticaria
● Gastrointestinal - nausea, vomiting, oral allergy syndrome which is so mild and
confined to the oropharyngeal area including swelling of the lips, tongue and
throat often associated with the ingestion of fresh fruits and vegetables;
abdominal cramps and pain; bloating, gas formation; fecal blood los;
malabsorption
● Respiratory - sneezing, itching, nasal congestion and inflammation of tissues of
the respiratory system, irregular breathing, and asthma, which is among the
more severe symptom
● Systemic - anaphylaxis, pallor, irritability, headaches, low blood pressure and
cardiac arrhythmias
● Anaphylactic shock - involves the GIT, the skin , the respiratory tract and the
cardiovascular system. Severe hypotension can occur and death can ensue
within minutes of ingestion of the offending food without proper treatment.
Allergic reactions are induced through the following:
○ Ingestion of food and drug (ingestants)
○ Contact with food, pesticides, drugs, adhesives, fur, hair, feathers,
molds, fungi (contactants)
○ Inhalation of pollen, dust mold, fungi, cosmetics, perfumes (inhalants)
○ Injection of vaccines, serum, antibiotics, hormones (injectants)
DIAGNOSIS ● Oral challenge - the patient is placed on a hypoallergenic diet and given a test
dose of the suspected food in capsule form, and the response is measured. The
test may be open, blind or double blind
● Skin testing - consists of scratch test, patch test or intradermal test. A dilute
extract of the food is placed on scratched skin, patched on or injected
intradermally. These tests are more accurate for non-food allergies and should
be followed up by oral challenge as there are many false positive responses for
food allergies
● RAST or radioallergosorbent extract test - blood sample is mixed with food
on a paper disk to measure antibody formation. This is expensive and less
accurate. It is useful if the patient is very sensitive and a true reaction must be
avoided
● ELISA or enzyme-linked immunosorbent assay - similar to RAST but does
not use a radioactive substance. It is also less expensive

NUTRITION ● Since there is no cure for food allergy, strict avoidance of the allergen is the only
MANAGEMENT way to avoid an adverse reaction. Successful avoidance of identified food
allergens relies on educating the patient to take appropriate avoidance
measures, with particular emphasis on hidden food ingredients and label
reading
● Provide guidelines on how to give nutritionally appropriate alternatives for the
excluded foods
○ Elimination diet - this is a diagnostic test diet and the usual offending
food such as protein-rich food are eliminated one after the other, until the
exact food causing the allergy is noted
○ Avoidance diet - an adequate diet which excludes the food causing
allergic reactions. Examples are milk-free diet, egg-free diet, wheat-free,
etc
○ Desensitization diet - the food causing the allergy is given gradually in
increasing amounts over a period of ten to twelve months. If the allergy
is noted again after twelve months, the person is given the avoidance
diet until the allergies has disappeared and desensitized once more
○ For infants and young children:
■ Introduce only one food at a time
■ Start with small amount of food, gradually increasing as tolerated
■ Try low allergen foods first (apple, banana, pear, carrot, zucchini
and rice)
■ Foods that are well-tolerated should be offered regularly

While any food can cause a food allergy, eight foods are responsible for 90% of all
food-induced allergic reactions in the United States. These major food allergies
include milk, eggs, fish, crustacean, shellfish, tree nuts, peanuts, wheat and soy

Note: Due to elimination of entire food groups, there is a risk for various vitamin and
mineral deficiencies
 Foods avoided Monitor intake of these nutrients

Fish Protein, niacin, vit B6, B12, E, phosphorus, and selenium

Shellfish Zinc, magnesium, copper and selenium

Eggs Vit D, B12, B6, pantothenic acid, selenium, riboflavin, and biotin

Corn Thiamin, riboflavin, iron and chromium

Milk Calcium, Vit A, D, riboflavin, pantothenic acid and phosphorus

Peanuts Niacin, magnesium, copper, manganese and chromium

Tree nuts Vit E, magnesium, copper, manganese and phosphorus

Soybeans Thiamin, riboflavin, Vit B6, folacin, calcium, phosphorus,

magnesium, iron and zinc

Wheat Thiamin, riboflavin, niacin, iron, selenium, fiber and chromium

DISORDER/DISEASES Skin Diseases

NUTRITIONAL ACUITY Level 1 -2

CHARACTERISTICS ● Skin abnormalities and Lesions Associated with Nutritional Factors

Protein deficiency - dry, scaly, inelastic, skin gray pallid, Dietary Rx: identification and correction
appearance of the nutritional deficiency

Essential fatty acid deficiency - eczematous skin lesions

Vitamin A Deficiency - follicular hyperkeratosis (goose

flesh-like lesions) and desquamation of epithelial cells

Riboflavin deficiency - seborrheic dermatitis with fine

greasy scales on erythematous base

Niacin deficiency - bilateral dermatitis with fine greasy

scales on an erythematous base

Ascorbic acid deficiency - the skin may show secondary

changes such as petechial hemorrhage and inelasticity

Hypervitaminosis A - skin lesions resemble those of Vit A Dietary Rx: Discontinue excessive
deficiency intakes of Vit A and carotene

Hypercarotenemia - yellow pigmentation of the skin

Phenylketonuria - an inborn error of phenylalanine Dietary Rx: Give low phenylalanine diet.
metabolism, one symptom of which is dry and Lofenalac is the trade name of a low
eczematous skin phenylalanine milk suitable for infants
and toddlers

● Acne Vulgaris
○ A chronic, inflammatory disease of the sebaceous glands, resulting from
the blocking of the glands and the formation of blackheads
○ The role of diet is not clear, but obesity and over consumption of rich,
greasy food and excessive sweets are possible factors
○ Diet Rx and management: A sensible diet adequate in all respect and
skin care (since an oily skin may also be a factor)

● Psoriasis
○ A skin disease the etiology of which is not certain and the cure is
unknown
○ A disorder of fat metabolism is the prevalent theory
MANAGEMENT ● Medical
○ ACTH and cortisone give temporary relief of symptoms
● Dietary
○ Restricted fat - to reduce secretion of sebaceous glands
○ Avoid excess protein - protein foods are frequent offenders in skin
disorders
○ Supplemental vitamins, especially A, C, D - for skin health
○ Low sodium if on steroid therapy - to prevent / minimize water retention
● Exposure to sunlight