Running Head: TREATING PATIENTS WITH FOOD ALLERGIES

TREATING PATIENTS WITH FOOD ALLERGIES IN THE DENTAL OFFICE

HOLLI SCHEXNIDER AND KATELYN CROUCH
LAMAR INSTITUTE OF TECHNOLOGY

TREATING PATIENTS WITH FOOD ALLERGIES

Abstract
This paper identifies and elaborates on the most common food allergies and their relativity to
different materials used in the dental office. Some patients may present with challenging food
allergies and the symptoms can range from a mild rash to life-threatening anaphylaxis. As the
clinician, it is important for us to be aware of and understand the ingredients in certain dental
materials to make the best decision for our patients. This paper specifically examines nut, milk,
and egg allergies, and their potential presence in common materials such as fluoride, dental
cements, resins, toothpastes, a cross-reactivity to Nitrous Oxide, and more. Dental materials and
medical histories should be examined thoroughly to ensure the safest treatment for each patient.

TREATING PATIENTS WITH FOOD ALLERGIES

Treating Patients with Food Allergies in the Dental Office

Food allergies have increased significantly over the past ten years. Approximately 15
million Americans are afflicted with some sort of food allergy or intolerance. Symptoms of a
food allergy can range from a mild rash to severe anaphylaxis shock. A person with food
allergies differs from one who may suffer from seasonal allergies. While seasonal allergies are
uncomfortable and annoying, they are only temporary. Food allergies are the ones that can be
life-threatening and are not seasonal. (Fagan, 2012). An allergic reaction occurs when the
antibody Immunoglobin E (IgE) is activated in the bloodstream and the immune system
responds. Reactions can occur immediately or may not appear for several hours following the
exposure. To ensure all of our patients are treated safely and effectively, it is important to
thoroughly review their medical history, inquire about any past allergic reactions, and plan their
treatment accordingly by reading the product labels. Many dental products may contain top
allergens such as peanut or tree nuts, milk protein, and egg protein or a very similar compound.
If a patient has a suspected or confirmed allergy to any of these allergens, the treatment plan
should be altered accordingly.
A peanut or tree nut allergy can be extremely dangerous, even fatal in some patients. ."In
a 2010 study of food allergies, rates of childhood peanut allergies - one of the most common and
most dangerous allergies - has more than tripled between 1997 and 2008. The Centers for
Disease Control and Prevention reported that the increase in food allergies has been seen in
children under 18 years old, and estimates that these children experience more than 300,000
ambulatory care visits per year related to food allergy. (Fagan, 2012). Some dental materials
may contain rosin, which comes from pine and spruce trees. In some instances, this may be
enough to produce a reaction. Materials that contain rosin include fluoride varnish, dental

TREATING PATIENTS WITH FOOD ALLERGIES

cements, impression materials, and polishing pastes. A cross-reaction between pine nuts and
colophony cannot be ruled out, so I recommend asking patients with peanut or pine nut allergies
to consult with their physicians to determine if they are also hypersensitive to rosin/colophony
before applying fluoride varnish (Mattana 2015). Few reactions have been reported, and further
research is still being conducted. However, as a precautionary measure it is detrimental to review
all product ingredients, to consult the patients primary physician before use, or avoid the use of
these products altogether. As of August 2016, VOCO Profluorid varnish has confirmed their
product to be safe and not contraindicated for patients with a nut allergy. VOCO states that their
product is derived from rosin found in the trunk of pine trees, and states that they have yet to find
any current scientific literature verifying a cross reaction between pine sap and nut allergic
patients; stating that the pine species has no relation to the nut species. (VOCO America Inc.
2014)
Cows milk protein allergy is another top allergen that typically affects children, but in
some cases it may progress into adolescence and adulthood. An allergy to cows milk protein,
which may also be called casein, is not the same as lactose-intolerance. Cows milk allergy is
common, occurring in up to 7% of children and usually presents in infancy. Most children with
milk allergy outgrow it (average age 5 years for IgE mediated and majority by age 3 years for
uncomplicated non-IgE mediated allergy) (A. T Fox 2013). Usually, a milk allergy is mild, but
anaphylaxis is possible. Milk is the third most common food, after peanuts and tree nuts, to
cause anaphylaxis (Mayo Clinic 2016). Dental materials that may contain milk protein include
Recaldent, some toothpastes, polishing pastes, and even Trident gum. Recaldent is derived from
casein and may be used to remineralize tooth structure, however if a patient presents with a milk
allergy, we would not use this product. Often times, dairy products are recommended during

TREATING PATIENTS WITH FOOD ALLERGIES

nutritional counseling due to the fact that milk and cheese are considered cario-static; but for an
allergic patient, it would be important to recommend meat protein, vegetables, and other fat
options. For the allergic patient who is attempting to quit tobacco, Trident gum would be
contraindicated.
Egg allergies are also a potential issue in the dental office and rank second among the
most common food allergies present in children. Adolescence and adults may also be affected by
an egg allergy, although this is less common. Symptoms may range from mild, such as hives, to
severe, such as anaphylaxis. As with all allergic patients, avoidance of a material containing egg
protein or a compound similar to, should be strictly avoided. While the whites of an egg contain
the allergenic proteins, patients with an egg allergy must avoid all eggs completely (the egg
white and the egg yolk). This is because it is impossible to separate the egg white completely
from the yolk, causing a cross-contact issue (FARE 2015). Nitrous Oxide is commonly used in
the dental office to provide a sense of relaxation to the anxious patient. Nitrous oxide does not
specifically contain egg, but it has a substance that is molecularly structured like eggs and
reactions have been reported (Fagan 2012). Patients with egg allergies should not receive
nitrous oxide as a precaution. Propofol is used to help a patient relax before and during general
anesthesia. While general anesthesia is not common in the dental setting, patients undergoing
orofacial surgery may receive propofol before their procedure. Propofol Formulations contain
egg lecithin, egg yolk phospholipids, and soybean oil. Consequently, some suggest that children
with allergies to egg and/or soybeans should not receive propofol, whenever possible. However,
the use of propofol in children with known egg allergies has been described with allergic
reactions occurring in approximately 2 percent of patients and no report of anaphylaxis. (Hofer

TREATING PATIENTS WITH FOOD ALLERGIES

KN, McCarthy MW, Buck ML, Hendrick AE. 2016). An alternative anesthetic should be used
for these patients, if an egg allergy is present.
While time is money in the dental office, our patients health and safety should be our
top priority. Medical histories should be thoroughly examined and questions should be asked and
answered appropriately to obtain the most detailed response from each patient. Many allergens
are present in the dental office, from latex, medications, and food. Most patients and clinicians
would not expect a reaction in the office due to a food allergy, but after researching many
different dental products, it is clear that there are many potential hazards to be aware of. As the
clinician, it is our job to ensure quality treatment for each patient. Careful decisions must be
made when choosing a dental material, and labels should always be read thoroughly in order to
help prevent an allergic reaction from occurring in our office.

TREATING PATIENTS WITH FOOD ALLERGIES

Sources

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http://www.foodallergy.org/allergens/egg-allergy
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procedural-sedation-outside-of-the-operating-room
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TREATING PATIENTS WITH FOOD ALLERGIES

6. Mattana, Durinda. (July 29, 2015). Is Fluoride Varnish a Risk for Patients With
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Allergies? Retrieved from Dimensions Of Dental Hygiene 70.

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