Adverse Food Reactions

Question 1

3 key questions

Answer 1

what happened?
what food?
how much food?

Question 2

IgE-med disorders

onset
common systems

Answer 2

rapid, usually during feeding, within 1-2 hrs

1 skin
2 GIT
respiratory less common

Question 3

non-IgE med

onset
system

Answer 3

hours to days

GI

Question 4

greatest foreign antigenic load

Answer 4

food allergens

Question 5

substance responsible for allergy

Answer 5

proteins

*alpha-gal - red meat

Question 6

top allergens (8, in order)

Answer 6

milk
egg
soy
fish
shellfish
peanut
wheat
rice :(

Question 7

class i vs class ii food allergen

sensitization occurs where
stability

Answer 7

i - sensitization at GIT; stable to heat, acid, proteases

ii - sensitization in resp tract or skin; heat-labile, susceptible to enzymatic degradation

Question 8

class i food allergen (primary sensitizers)

MW
oks na ‘to if ok naman pagkaluto
*water-soluble

Answer 8

10-70kD

false

*ex.
cow milk - caseins, albumin
chicken egg
peanut - glycinin, vicillin
soybean - trypsin inhibitor
shrimp - tropomyosin
fish - paralbumin
lipid transfer proteins - apple apricot peach plum corn

Question 9

class ii food allergen (cross-reactive)

generally what material
usually what
skin test?

Answer 9

plant-derived
fresh food
none, cos difficult to isolate

Question 10

clinical consequence of unnecessary modification of diet

Answer 10

vit and min deficiency, malnutrition

Question 11

skin prick test:

when to observe
when positive
pos/neg predictive value

Answer 11

15 mins

3mm > (-)

<50%
>95%

• sensitivity 90
• specificity 50

Question 12

inter test comparison (spt vs serum food ige test)

Answer 12

spt +

ige +++

Question 13

tests are designed for screening t/f

Answer 13

false. skin tests are diagnostic aids

Question 14

food vs aeroallergens: predictive value whatever

Answer 14

for aeroallergens, positive results are more predictive!

Question 15

peanut epitopes implicated in allergy (3)

Answer 15

ara h1 vicillin
ara h2 conglutin
ara h3 glycinin

Question 16

uses allergenic ptns derived from recombinant dna tech or purification from natural sources; can ID specific IgE reactivity to recombinant allergenic ptns rather than whole antigen

Answer 16

component-resolved diagnosis (crd)

Question 17

goat milk is a good alternative for cow’s milk t/f

Answer 17

false, mare’s milk is better? hehe only 5% cross reactivity.

most beans also have a low reaction rate, with peanuts

Question 18

when to consider that child is allergic and will not undergo food challenge

<2y/o, >2/yo
cow’s milk
egg
peanut

Answer 18

use 100% diagnostic spt cut off values…. ???? what it mean

cow milk >=6, >=8
egg >=5, >=7
peanut >=4, >=8

Question 19

expensive and slightly less negative test than SPT, but can be used as a basis to avoid oral challenge, predict prognosis and time interval to do oral challenge if FA is outgrown

Answer 19

FEIA fluorescence enzyme immunoassay

peanut 14 kU/L
fish 20 kU/L

Question 20

food challenges can be used in non-ige FA

Answer 20

true. may be used in both ige and non-ige

Question 21

gold standard food challenge

Answer 21

DBCFC double blind placebo controlled food challenge

Question 22

when to consider ofc (3)

Answer 22

ambiguity in hx and testing
further clarity
possible outgrown allergy

Question 23

FA management (4)

Answer 23

APIE

avoidance
plan for accidental exposure
insurance of sufficient diet
educate (allergens in other food; read label, how to use epinephrine, which best treated with AH)

Question 24

immunotherapy for FA!

Answer 24

NOT RECOMMENDED

Question 25

which allergens are commonly outgrown (2), and which are not (3)

Answer 25

outgrown: milk, egg
not: peanut, nut, seafood

Question 26

cooking allergenic food: ??

Answer 26

*specific epitope

if linear -> breakdown
conformational -> open more :c

Question 27

prevention

breastfeeding
solid
low-risk foods
highly allergenic foods
pregnancy/nursing
soy

Answer 27

bfeeding 4-6 months

then solid foods after

low-risk complementary foods one at a time

potentially highly allergenic foods after low-risk foods

DON’‘T avoid allergenic foods during pregnancy/nursing

soy-based formula DO NOT prevent allergic disease