Allergic GI diseases, Allergic rhinitis, Conjunctivits Flashcards
How to test for IgE mediated food allergies
- skin prick test
- specific IgE
How to test for non-IgE mediated food allergies
- atopy patch test
Food allergy classification
IgE mediated
- immediate GI hypersensitivity
- Pollen associated allergy syndrome
non-IgE mediated disorders
- food protin induced enterocolitis syndrome (FPIES)
- food protein induced allergic proctolitis (AP)
- food protein enteropathy
mixed IgE and cell-mediated
- eosinophilic esophagitis
- eosinophilic gastritis
- eosinophilic gastroenteritis
- Eosinophilic colitis
Immediete gastrointestinal hypersensitivity
- igE mediated mast cell degranulation
- nausea, vomiting, diarrhea, colic or abdominal pain within minutes to 2 hours after ingestions
- latent allergen exposure: vomiting may be followed by anorexia, poor weight gain, abdominal pain and colic
Immediete gastrointestinal hypersensitivity
- diagnosis and treatment
- Sensitization to the food
- Oral food challenge
Treatment:
- dietary therapy
Oral allergy syndrome
IgE mediated mast cell degranulation
- itching, burning, erythema or tingling of the lips, tongue, palate or oropharynx wihtin minutes or during raw allergen ingestions
- resolution shortly afterwards
Oral allergy syndrome
- diagnosis and treatmetn
- sensitization to the plant food
- Sensitization to pollen
- Correlation between the plan food(s) in question and pollens to which the patient is sensitizes
+/- oral food challenge
Treatment:
avoidance of raw foods
Eosinophilic esophagitis
- T-cell and IgE mediated mechanisms
- feeding dysfunction, vomiting, abdominal or chest pain, dysphagia, odynophagia, food impaction
Eosinophilic esophagitis
- diagnosis and treatment
- Endoscopic abnormalities
- Histopathological abnormalities
+/- sensitization to food
+/- oral food challenge
Treatment
- Dietary therapy
- PPI
- Local glucocorticoids
Eosinophilic gastritis and Gastroenterocolitis
- T-cell and IgE mediated mechanisms
1. Mucosal: nausea, vomiting, abdominal pain and diarrhea; ot may be associated with occult blood loss, iron deficiency anemia, protein losing enteropathy, failure to thrive
2. Muscular: obstructuve symtpoms, mimicking pyloric stenosis or thickening of the gastric outlet
3. Serosal: asites and abdominal pain
Eosinophilic gastritis and Gastroenterocolitis
- diagnosis and treatment
- Endoscopic abnormalities
- Histopathological abnormalities
+/- sensitization to food
+/- oral food challenge
Treatment:
- Cromolyn
- Systemic glucocorticoids
Eosinophilic esophagitis endoscopic signs
- edema
- rings
- white exudate
- furrows
- strictures
- combination
Eosinophilic gastroenteritis endoscopic signs
nodularity and polypoid mucosa of tha antrum
Eosinophilic esophagitis histologic signs
- over 15 eosinophis/ HPF
- over 20 eosinophils/ HPF
- fibrosis
- eosinophil degranulation
- basal layer hyperplasia
- microabscess
Eosinophilic gastroenteritis histologic signs
- over 30 eosinophils/ HPF
Food protein-induced enterocilitis syndrome (FPIES)
- t-cell mediated mechanisms
ACUTE
- repetitive vomiting and lethargy 1-3 hours, ill appearing, hypotensive, diarrhea within 2 to 10 hours, dehydration, pallor, hypothermia
CHRONIC
- diarrhea, occasional mucus, abdominal distention, intermittent comiting, dehydration and lethary, failure to rhive and poor weight gain, weight loss, enamia, hypoproteinemia and hypoalbuminemia
Food protein-induced enterocilitis syndrome (FPIES)
- diagnosis and treatment
Diagnosis:
- elimination diet
+/- sensitization to the food (SPT, APT)
+/- oral food challenge
treatment
- dietary therapy
- emergency plan
Food protein induced allergic proctolitis (AP)
- t-cell mediated
- multiple daily stools with visible blood, mucous-streaked stools that are hemoccult positive, infrequent stools with occasional bleeding
Food protein induced allergic proctolitis (AP)
- diagnosis and treatment
diagnosis - elimination diet - reintroduction at home \+/- microscopic stool exam \+/- CBC
treatment
- dietary therapy
Foor protein- induced enterophaty (FPE)
- t- cell mediated
- diarrhea, failure to thrive , emesis and abdominal distention, malabsorption with steatorrhea, lack of acute symtpoms
Foor protein- induced enterophaty (FPE)
- diagnosis and treatment
diagnosis:
- laboratory studies to confirm malabsorption
- moderate anemia
- hypoproteinemia
- prolonged coagulation time
- jejunal biopsies with villous atrophy and crypt hyperplasia
treatment:
- dietary therapy
FPIES emergency treatment plan
MILD (1-2 epidoses of emesis and no or mild lethargy)
- oral rehydration and treating with antiemetic if patient is over 6 months old
MODERATE (> 3 episodes of emesis with or without moderate lethargy)
- ondansetron (antiemetic) if patient is > 6 mo
- peripheral iv line with saline
SEVERE (> 3 episodes of emesis, severe lethargy, hypotonia and/or cyanotic appearance)
- peripheral iv line with saline
- methylprednisolone
- epihenphrine i.m.
- correct electrolyte abnormalities
- noninvasive monitoring of BP and HR
Which formula to choose?
AAF: anaphylaxis, FPIES, cow’s milk protein induced enteropathy
eHF: urticaria, eczema, immediate GI allergy, eosinophilic esophagitis, GERD, cow milk protein induced gastroenteritis and proctolitis, colic, constipation/diarrhea
Allergic rhinoconjunctivitis symptoms
two or more symptoms that last > 1 hours
- rhinorrhea
- sneezing (often paroxysmal)
- stuffy nose
- itching of nose
- dennie-morgan lines
- allergic shinners
- conjunctival erythema
- +/- conjunctivitis
- +/- itching og palate/ inner ear
