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Clinical Strategies to Combat Food Allergies and Intolerances
Robert Iafelice, MS, RD, LDN
Edited by
Mary Ann Cockram, MS, RD and Wolf J. Rinke, PhD, RDN

C336
12 CPEUs
HARD COPY
$104.95
C336E
12 CPEUs
ELECTRONIC
$99.95

Manual with 1 reporting form, 106 pgs.
Approximately 10% of U.S. adults have a food allergy, and nearly twice as many adults believe they have a food allergy. Of children, 8% have a food allergy, and 40 % have multiple food allergies. Plus, food intolerance affects 15% to 20% of the population. This comprehensive CPE program will enable you to get up-to-date on this widespread and growing public health problem. More specifically it will enable you to:

  • Provide expert dietary management of food allergies and intolerances in accordance with evidence-based recommendations.
  • Counsel parents on the critical importance and safety of the new guidelines for the early introduction of allergenic foods, viz. peanut.
  • Offer expert advice on the potential benefits of selected dietary supplements in the management and prevention of food allergies and intolerances.
  • Compare and differentiate celiac disease, non-celiac gluten sensitivity, and wheat allergy.
  • Describe allergic conditions associated with a food allergy, including eosinophilic esophagitis and food-dependent exercise-induced anaphylaxis.

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Approved/Accepted by CDR, NCBDE

For RDs/RDNs & DTRs/NDTRs for the Professional Development Portfolio

SUGGESTED Learning Need Codes:
2000, 2040, 2060, 2080, 3000, 3005, 3010, 3060, 3100, 4050, 4120, 4130, 4140, 5000, 5060, 5070, 5080, 5090, 5100, 5110, 5200, 5210, 5220, 5420, 5440, 6020, 6080

SUGGESTED Performance Indicators (PIs):
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To order an ADDITIONAL Reporting Form click below:

C336F
12 CPEUs
REPORTING FORM
$40.00

Clinical Strategies to Combat Food Allergies and Intolerances
Robert Iafelice, MS, RD, LDN
Edited by
Mary Ann Cockram, MS, RD and Wolf J. Rinke, PhD, RDN

© 2020 Wolf Rinke Associates, Inc. All rights reserved for all portions of this program. Reproduction in whole or part without written permission, except for brief excerpts, is prohibited.

OVERVIEW AND INSTRUCTIONS

The field of food allergy and food intolerance is very complex and confusing. While approximately 1 in 10 U.S. adults have a food allergy, nearly twice as many US adults believe they have a food allergy. Food intolerances are often mistaken for food allergies. Food allergies can be life-threatening, whereas food intolerances are rarely a severe health concern.Adding further to the confusion, the management, and assessment of food allergies may vary from clinic to clinic.
Currently, the standard of care for food allergies and intolerances is limited to allergen avoidance or treatment of symptoms.Nevertheless, new and emerging therapies are showing promise. For example, studies show that oral and sublingual immunotherapy can desensitize people with food allergies; an early introduction of peanut-containing foods can prevent the development of peanut allergy in many children;and supplementation with probioticsand vitamin D can induce immune tolerance and may prevent food-induced reactions.
Food allergy is a serious public health burden and is steadily increasing in prevalence. Approximately 8% of children have a food allergy, and 40 % of those children have multiple food allergies. Food intolerance affects 15% to 20% of the population and is also on the rise. In both conditions, nutrition and dietetics practitioners play a critical role in maintaining nutritional adequacy, particularly when staple foods are excluded for extended periods. Furthermore, many people are needlessly avoiding foods solely based on results of unproven and costly food sensitivity testing. RDNs and NDTRs need to lead the way in providing expert guidance on the management of food allergies and intolerances. That is why it is imperative that they stay well-informed about this widespread and growing public health problem.
This CPE program is a level 2 Continuing Professional Education (CPE) program approved for twelve (12) continuing professional education units (CPEUs). That means that the reader has a general knowledge of the literature and professional practice in the area covered. The focus of the program is to enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to the following four steps:
Step 1: Review the objectives for the CPE program.
Step 2: Study each chapter. As you read, think of patients from your own practice who fit the situation described.
Step 3: Assess what you have learned by completing the self-assessment instrument at the end of this CPE program.
Step 4: Compare your answers to the answer key that has been provided. If you score at least 80% (40 questions) correct, you are ready to transfer your answers to the CONTINUING PROFESSIONAL EDUCATION REPORTING FORM. If you scored less than 80% correct, re-read the appropriate sections of the program and re-test yourself until you score at least 80% (40 questions) correct.
After you have successfully completed the program, complete the CPE REPORTING FORM and:
Submit online at www.easyCPEcredits.com,
Or fax to (410) 531-9282,
Or mail to Wolf Rinke Associates, Inc., 13621 Gilbride Lane, Clarksville, MD 21029.
Upon receipt of your CPE Reporting Form, we will email you a Certificate of Completion within 3-5 business days.

OBJECTIVES

Upon completion of this CPE program, you will be better able to:

  • Discuss the various types of food allergies and food intolerances: their pathophysiology, clinical manifestations, and how they differ.
  • Recognize the strong association between imbalances in the gut microbiota and the increasing rate of food allergy, and how this interaction is impacted by diet and probiotics.
  • Educate patients on the recommended methods of food allergy testing and proper follow-up versus unproven and misleading food sensitivity testing.
  • Provide expert dietary management of food allergies and intolerances in accordance with evidence-based recommendations.
  • Apply maternal diet and supplement strategies for food allergy prevention to pregnant women at high risk of having children with allergies.
  • Counsel parents on the critical importance and safety of the new guidelines for the early introduction of allergenic foods, viz. peanut.
  • Offer expert advice on the potential benefits of selected dietary supplements in the management and prevention of food allergies and intolerances.
  • Identify signs and symptoms of food-induced anaphylaxis.
  • Compare and differentiate celiac disease, non-celiac gluten sensitivity, and wheat allergy.
  • Explain the cause and development of oral allergy syndrome.
  • Assess which patients might benefit from a low FODMAP diet.
  • Describe allergic conditions associated with a food allergy, including eosinophilic esophagitis and food-dependent exercise-induced anaphylaxis.

TABLE OF CONTENTS

CHAPTER 1 Background
FOOD ALLERGY – IMMUNE-MEDIATED
IgE
Food-Induced Anaphylaxis (FIAn)
Oral Allergy Syndrome (OAS)
Contact Urticaria
Non- IgE
Food Protein-Induced Enterocolitis Syndrome (FPIES)
Allergic Proctocolitis (AP)
Food Protein-Induced Enteropathy (FPE)
Celiac Disease (CD)
Allergic Contact Dermatitis
Mixed IgE and Non-IgE
Atopic Dermatitis (AD)
Eosinophilic Esophagitis (EoE)
Eosinophilic Gastroenteritis (EGE)
FOOD INTOLERANCE – NON-IMMUNE MEDIATED
Metabolic Mechanism
Lactose Intolerance
FODMAPs
Non-Celiac Gluten Sensitivity (NCGS)
Pharmacologic Mechanism
Toxic Mechanism
Undefined Mechanisms 10
ASSOCIATED CONDITIONS
Asthma 10
Exercise-Induced Anaphylaxis (EIAn)
Increased Intestinal Permeability
CHAPTER 2 The Gut Microbiota and Food Allergy
IMMUNE TOLERANCE
DYSBIOSIS
Gut Barrier Function
Regulatory T cells
ENVIRONMENTAL/LIFESTYLE FACTORS
Diet
Fiber
Polyphenols
Fermented Foods/Probiotics
CHAPTER 3 Diagnosis of Nonacute Food Allergies and Intolerances
MEDICAL HISTORY AND PHYSICAL EXAMINATION
TESTING
Skin Prick Tests (SPTs)
Other Skin Tests
Allergen-Specific Serum IgE (sIgE) Testing
Breath Tests
ELIMINATION DIET
ORAL FOOD CHALLENGES
FOOD-SPECIFIC IgG TESTING
CHAPTER 4 Management of Nonacute Food Allergies and Intolerances
DIETARY AVOIDANCE
Specific Allergens
Cross-Reactivities
Shellfish
Fish
Peanut and Tree Nuts
Tree Nuts
Legumes
Cow’s Milk
Grains, Fruits, and Vegetables
Education and Dietary Counseling
Nutritional Status
Food Labeling
Management Outside the Home
Re-evaluating Patients with Food Allergies
VACCINES AND EGG ALLERGY
Influenza (Flu) Vaccine
MMR (Measles, Mumps, and Rubella) Vaccine
Rabies Vaccine and Yellow Fever Vaccine
PHARMACOLOGIC INTERVENTIONS
Antihistamines
Oral Cromolyn
FOOD IMMUNOTHERAPY
Oral Immunotherapy (OIT)
Sublingual Immunotherapy (SLIT)
Epicutaneous Immunotherapy (EPIT)
Adjuvant Anti-IgE Therapy
DIETARY SUPPLEMENTS
Probiotics, Prebiotics and Synbiotics
Glutamine
Quercetin
Vitamin D
Digestive Enzymes
Omega-3 Fatty Acids
Curcumin
CASE STUDY 1
CASE STUDY 2
CHAPTER 5 Diagnosis and Treatment of Food-Induced Anaphylaxis
DIAGNOSIS
TREATMENT
Epinephrine
Adjunctive Treatment
Antihistamines
Bronchodilators
Corticosteroids 48
Long-term Management
Seek Support
Allergen Identification and Avoidance
Follow-up with Specialty Care
Epinephrine for Emergencies
CHAPTER 6 Early Prevention of Food Allergies
MATERNAL DIET DURING PREGNANCY AND LACTATION
Maternal Allergenic Food Avoidance
Maternal Probiotic Supplementation During Pregnancy and Lactation
Maternal Fish Oil Supplementation During Pregnancy
BREASTFEEDING
INFANT FORMULAS
Hydrolyzed Infant Formula (HF)
Soy Infant Formula
Amino Acid-Based Infant Formula (AAF)
EARLY INTRODUCTION OF POTENTIALLY ALLERGENIC FOODS
CHAPTER 7 Summary/Conclusion
REFERENCES
FOR YOUR CONTINUING EDUCATION
LIST OF ABBREVIATIONS
GLOSSARY
RESOURCES
SELF-ASSESSMENT QUESTIONS
ANSWER KEY
EXPLANATIONS FOR THE ANSWERS
ABOUT THE AUTHOR
ABOUT THE EDITORS

ABOUT THE AUTHOR

Robert Iafelice, MS, RD, LDN is a freelance medical writer and member of the American Medical Writers Association. He has contributed several chapters to the 6th edition of Disease Prevention and Treatment, a medical reference book of evidence-based protocols to combat the diseases of aging. Among the protocols he authored, “Celiac Disease and Non-Celiac Gluten Sensitivity” is particularly relevant to this CPE program.
Robert received a Bachelor of Arts degree in Chemistry from Miami University in Oxford, Ohio, and a Master of Science degree in Nutrition Science from Case Western Reserve University in Cleveland, Ohio. Most of his experience as a practicing registered dietitian was in the field of integrative/functional medicine with a focus on food allergy. Robert provided medical nutrition therapy at an integrative allergy-immunology clinic in Chicago, where he specialized in conducting double-blind, placebo-controlled food challenges – the gold standard for food allergy diagnosis.
Robert’s diverse background also includes extensive experience in fitness/wellness as a gym owner, university nutrition instructor, health educator in the nutraceuticals industry, and oncology. His other writing interests include intermittent fasting, nutritional ketosis, and high-intensity interval training.

ABOUT THE EDITORS

Mary Ann Cockram, MS, RD is retired from Abbott Nutrition where she was a Research Scientist in the Scientific and Medical Affairs group. In this role, she provided clinical nutrition education and brand support internally to Sales and Marketing and externally to clinicians and consumers for Abbott’s critical care and surgical enteral nutrition products. Her area of interest is enteral feeding.
Mary Ann received a Bachelor of Science degree in Home Economics from Valparaiso University in Valparaiso, IN, and a Master of Science degree in Clinical Nutrition from Rush University in Chicago.
Mary Ann has served as chair of the Medical Nutrition Practice Group, and as the assistant editor and editor of Medical Nutrition Matters, the newsletter of this practice group. Mary Ann continues to write continuing professional education test questions for the articles in Medical Nutrition Matters. She participated as an evidence analyst on the Evidence Analysis Team for Adult Weight Management for the Academy of Nutrition and Dietetics, and she attended the test item writer workshop sponsored by the Commission on Dietetic Registration.

Wolf J. Rinke, PhD, RDN is the president and founder of Wolf Rinke Associates, Inc., a company that has provided high-quality CPE programs to nutrition and dietetics practitioners since 1990.
Dr. Rinke earned a BS at Drexel University, an MS at Iowa State University, a PhD in Continuing and Vocational Education (Adult Ed) at the University of Wisconsin and interned at Walter Reed Army Medical Center. He participated in a test item writer workshop sponsored by the Commission on Dietetic Registration (CDR).
Dr. Rinke is a past Adjunct Associate Professor, Graduate School of Management & Technology at the University of Maryland, and a former Adjunct Faculty Member of the School of Continuing Studies at The Johns Hopkins University.
He has served as past president of the District of Columbia (DC) Dietetic Association and has been honored by the Academy of Nutrition and Dietetics with the Award for Excellence in the Practice of Management, the Outstanding Dietitian of the Year Award, and the Outstanding Service Award, in addition to delivering the Lenna Frances Cooper Lecture.
Dr. Rinke has served in numerous leadership roles at the Academy of Nutrition and Dietetics: Chair of the Scholarship Committee for Dietitians in Business and Communications; Chair of the Communication Committee, Honors Committee, and Licensure Panel and Ethical Practices Task Force for the Commission on Dietetic Registration; Chair of the Area Coordinating Committee and Chair for the Code of Ethics; Member of the Resource for Education Programs Committee; Member of the House of Delegates; and Member of the Board of Directors.
Dr. Rinke is the author of more than 500 articles, numerous CPE self-study programs, and several popular books including Make It a Winning Life: Success Strategies for Life, Love and Business; Winning Management: 6 Fail-Safe Strategies for Building High-Performance Organizations; and Don’t Oil the Squeaky Wheel, and 19 Other Contrarian Ways to Improve Your Leadership Effectiveness.

ACKNOWLEDGMENTS

Special thanks to the following individuals for their careful review of this CPE program.

Martha Archuleta, PhD, RDN
Professor- Nutrition, Dietetics & Food Sciences Dept.
Director- Master of Dietetics Administration Program
Utah State University
Salt Lake Center, UT 

Jennifer Dickert, RDN, LD
Super Natural Nutrition
Dover, NH

Susanne Trout, MS, RDN, LDN, IBCLC
Director – Enteral Feeding Preparation
Mothers’ Milk Bank & Lactation Services
Children’s Hospital of Philadelphia
Philadelphia, PA

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