Tree nut and peanut consumption in relation to chronic and metabolic diseases including allergy.

The New and Emerging Research session highlighted the emerging understanding of both the positive and negative effects of nuts consumption on health. The limited nature of both experimental and epidemiological evidence for positive relationship(s) between nut intake and health were noted. Study inconsistency and limitations, particularly survey methodology, were explored. Recent results from epidemiologic studies indicating a potential negative association between nut and seed intake and cancer risk were reviewed. The ability of walnuts to reduce endothelin suggests an interesting biochemical mechanism of nut action that may affect other endothelin-associated diseases, which should be further explored. The effects of nuts and their constituents on a nuclear receptor screen (PPARalpha, beta/delta, gamma, LXRalpha, beta, RXRalpha, beta, gamma, PXR, and FXR) have been explored. Nut allergenicity and approaches necessary to minimize this effect were also described. In contrast to the positive effects, nut allergies present tree nut-allergic consumers with health challenges. The Food Allergy and Anaphylaxis Network stressed the importance of ensuring that consumers with food allergies have legible, accurate food labels. The Food Allergen Labeling and Consumer Protection Act has engendered precautionary, worst-case allergen scenario labeling statements with unknown benefits to consumer health. Issues of cross-contamination due to shared equipment and shared facilities highlighted the need to rely on allergen control programs that use ELISA technology and have increased understanding of nut allergens. Ultimately, to maximize the positive benefits of nuts, the consumer must be provided with all the information required to make an informed choice.

Bullying among pediatric patients with food allergy.

BACKGROUND: There are reports of children and teens with food allergy being harassed because of their food allergy, yet no study to date has attempted to characterize these occurrences. OBJECTIVES: To determine the presence and characteristics of bullying, teasing, or harassment of food-allergic patients owing to their food allergies. METHODS: Questionnaires were completed by food-allergic teens and adults and by parents of food-allergic children. RESULTS: A total of 353 surveys were completed. Because most food-allergic individuals were children, most surveys were completed by parents of food-allergic individuals. The ages of the food-allergic individuals were younger than 4 years (25.9%), 4 to 11 years (55.0%), 12 to 18 years (12.5%), 19 to 25 years (2.6%), and older than 25 years (4.0%). Including all age groups, 24% of respondents reported that the food-allergic individual had been bullied, teased, or harassed because of food allergy. Of those who were bullied, teased, or harassed, 86% reported multiple episodes. Eighty-two percent of episodes occurred at school, and 80% were perpetrated mainly by classmates. Twenty-one percent of those who were bullied, teased, or harassed reported the perpetrators to be teachers or school staff. Overall, 79% of those bullied, teased, or harassed attributed this solely to food allergy. Of those bullied, 57% described physical events, such as being touched by an allergen and having an allergen thrown or waved at them, and several reported intentional contamination of their food with allergen. CONCLUSIONS: Bullying, teasing, and harassment of children with food allergy seems to be common, frequent, and repetitive. These actions pose emotional and physical risks that should be addressed in food allergy management.

Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanuts.

BACKGROUND: Foods with advisory labeling (eg, "may contain") are increasingly prevalent. Consumers with food allergies might ignore advisory labeling advice. OBJECTIVE: We sought to determine whether consumers with food allergy heeded advisory labels and whether products with advisory labels contained detectable peanut allergen. METHODS: Surveys (n = 625 in 2003 and n = 645 in 2006) were conducted at Food Allergy & Anaphylaxis Network patient conferences. Food products bearing advisory statements regarding peanuts were analyzed for the presence of peanut. RESULTS: Consumers were less likely to heed advisory labeling in 2006 (75%) compared with in 2003 (85%, P < .01); behavior varied significantly according to the form of the statement. Peanut protein was detected in 10% (20/200) of total food products bearing advisory statements, although clinically significant levels of peanut (>1 mg of peanut or >0.25 mg of peanut protein) were detected in only 13 of 200 such products. CONCLUSION: Consumers with food allergy are increasingly ignoring advisory labeling. Because food products with advisory labeling do contain detectable levels of peanuts, a risk exists to consumers choosing to eat such foods. The format of the labeling statement did not influence the likelihood of finding detectable peanut, except for products listing peanuts as a minor ingredient, but did influence the choices of consumers with food allergy. CLINICAL IMPLICATIONS: Allergic patients are taking risks by increasingly disregarding advisory labeling.

Impact of ingredient labeling practices on food allergic consumers.

BACKGROUND: Food allergic consumers depend on ingredient labels for allergen avoidance, and the modality of labeling is changing. OBJECTIVE: To investigate current responses to food labels so that the impact of future label changes can be anticipated. METHODS: Adults who attended Food Allergy & Anaphylaxis Network conferences completed a survey regarding their experiences with food labels for their family's most severely affected food allergic individual (FAI). RESULTS: There were 489 completed surveys (84% participation). Most FAIs were young (41% <4 years of age and 56% 4-18 years of age) and highly atopic (51% had asthma and 69% had atopic dermatitis). Food allergies included the following: peanut, 81%; tree nuts, 53%; milk, 51%; egg, 51%; and soy, 17%. All chocolate products were avoided by 37% of FAIs who were avoiding peanut and 40% who were avoiding tree nuts; 91% of tree nut allergic FAIs avoided all tree nuts. Of FAIs who avoided soy, 41% avoided soybean oil and 38% avoided soy lecithin. Of those who avoided milk, 82% avoided lactose. Allergic reactions were attributed to misunderstanding label terms (16%) and to nonspecific terms (spice, flavor) (22%). Ingredient labels were "always" or "frequently" read before purchase by 99%. Product brand choice was "very much influenced" by the manner of labeling for 86%, and manufacturers were contacted for more information by 86%. CONCLUSIONS: Our results suggest that improved product allergen labeling will reduce allergic reactions and simplify allergy management. However, the new labeling may not indicate the form or source of the allergen, and individuals who do not currently avoid foods with minimal or irrelevant protein content, such as soy oil or soy lecithin, may face additional ambiguity and unnecessary dietary restrictions.

Impact of food allergies on school nursing practice.

Food allergies affect 11 million Americans, including 6-8% of children. The rate of peanut allergies in children doubled from 1997 to 2002. There is no cure; therefore, strict avoidance of the allergen is the only way to avoid a reaction. Fatalities are associated with delays in or lack of epinephrine administration. Severe reactions, called anaphylaxis, have occurred in schools. In a nationwide telephone survey of 400 elementary school nurses, 44% reported an increase in children with food allergies in their schools over the last 5 years; more than one third had 10 or more students with food allergies; 78% did staff training as a preventive strategy, with 74% developing their own training guidelines; and 90% stated students' epinephrine was stored in the nurse's office. Standardized training in food allergies as well as timely access to epinephrine is needed to respond appropriately to an anaphylactic reaction in the school setting.