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Medical Nutrition Therapy > Chapter 25: Medical Nutrition Therapy for Adverse Reactions to Food: Allergies and Intolerances > Flashcards

Chapter 25: Medical Nutrition Therapy for Adverse Reactions to Food: Allergies and Intolerances Flashcards

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USMLE® Step 1 flashcards
1
Q

adverse reactions to food

A

Encompass food allergies and food intolerances, both of which can involve multiple systems, cause diverse symptoms, and negatively impact health

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2
Q

food allergy

A

An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food

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3
Q

food sensitivity

A

A term used when it is unclear whether the reaction is immunologically related or due tot a biochemical or physiological defect

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4
Q

food autoimmune or immune reactivity

A

The concept that when the body’s normal tolerance of friendly antigenic substances is disrupted because of disease, injury, shock, trauma, drugs, or blood transfusion, the ingestion of foods containing antigenic substances with a composition similar to those of the body’s autoantigens can result in the production of antibodies that react to the food antigens and the body’s own tissues

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5
Q

sensitivity related illness (SRI)

A

A condition that occurs when an individual is exposed to some type of toxin or stressor and then becomes sensitive to a food, inhalant, or chemical, although the mechanisms are unclear

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6
Q

epigenetic

A

Modifications of the genome

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7
Q

atopic dermatitis

A

Hereditary eczematous rash

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8
Q

antibodies

A

Specialized immune proteins that are produced in response to the introduction of an antigen into the body

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9
Q

antigen

A

An allergen, toxin, or foreign substance

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10
Q

immunoglobulins (Ig)

A

Because of their association with the immune system, antibodies are referred to as immunoglobulins. Five distinct classes of antibodies have been identified: IgA, IgD, IgE, IgG, and IgM

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11
Q

lymphocyte

A

White blood cell

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12
Q

B-cells

A

A group of lymphocytes. Arise from stem cells in the bone marrow

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13
Q

T-cells

A

A group of lymphocytes. Originate from stem cells but later transported to the thymus gland where they mature

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14
Q

antigen-presenting cell (APC)

A

A cell that displays specific molecules of a material on their surfaces

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15
Q

epitope

A

The antigenic component displayed on the surface of antigen-presenting cells (APC)

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16
Q

cytokines

A

Chemical messengers

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17
Q

Th cells

A

Helper cells that adjust the system

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18
Q

Th1 cells

A

Regulate the activities of the B-cells to produce antibodies and direct damage to target cells, resulting in the destruction of antigens

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19
Q

Th2 cells

A

Mediate the allergic response by regulating the production of B-cells of IgE sensitized to food or other allergens

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20
Q

T-regulatory cells (T-reg cells)

A

Regulate the immune response so that there is tolerance of the foreign but safe molecule

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21
Q

T-suppressor cells

A

Regulate the immune response so that there is tolerance of the foreign but safe molecule

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22
Q

granulocytes

A

Cells that contain intracellular granules, which act as storage depots for defense chemicals or inflammatory mediators that, when released, not only protect the body from invading pathogens but also can produce allergic symptoms

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23
Q

mast cells

A

A type of granulocyte. Located in the lungs, skin, tongue, and linings of the nose and intestinal tract

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24
Q

basophils

A

A type of granulocyte. Are in circulation

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25
Q

eosinophils

A

A type of granulocyte. Found in blood and tissues and, when stimulated by cytokines produced by Th2 cells, migrate to the site of an allergic reaction

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26
Q

inflammatory mediators

A

Released when granulocytes degranulate. These mediators have a specific effect on local tissues and at other sites, resulting in the symptoms of an allergic reaction

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27
Q

oral tolerance

A

The mechanism by which potentially antigenic substances do not trigger an immune response and is the normal physiologic response to ingested antigens

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28
Q

dendritic cells (DC)

A

A type of antigen-presenting cell (APC)

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29
Q

B-regulatory (B-reg) cells

A

B-cells inhibit hostile immune reactivity. Act mainly through interleukin-10 (IL-10), an anti-inflammatory cytokine to reduce infection and allergic inflammation and to promote tolerance

30
Q

sensitization

A

Can take place in the gastrointestinal tract, oral cavity, skin, and occasionally in the respiratory tract

31
Q

microbiome

A

The collection of different types of microbes that live inside the gut

32
Q

dysbiosis

A

When there is an imbalance in the microbial ecosystem

33
Q

increased intestinal permeability aka “leaky gut”

A

The increased likelihood that intact food proteins and peptides will pass through the intestinal lumen and reach the lymphoid tissue, leading to immune sensitization and possible reactivity

34
Q

gut-associated lymphoid tissue (GALT)

A

The largest mass of lymphoid tissue in the body and antigen penetration and presentation to the GALT drives food sensitization

35
Q

IgE-mediated reactions

A

Occur when sIgE produced in response to the presence of the allergen attaches to matching sIgE antibodies on the mast cell or basophil, forming a “bridge” between them. This bridging activates the mast cell or basophil by a series of energy-requiring processes resulting in the cell’s degranulation and release of the inflammatory mediators, and the appearance of allergic symptoms

36
Q

Non-IgE-mediated reactions

A

Based on the activation of cells other than IgE, such as eosinophils, and their degranulation and release of mediators. These reactions are present in delayed or chronic reactions to food allergen ingestion

37
Q

cow’s milk protein allergy (CMPA)

A

An allergic response to proteins found in cow’s milk

38
Q

anaphylaxis

A

An acute, systemic, often severe, and sometimes fatal immune response that usually occurs within a limited period following exposure to a food antigen. Multiple organ systems are affected. Symptoms include respiratory distress, abdominal pain, nausea, vomiting, cyanosis, arrhythmia, hypotension, angioedema, urticaria, diarrhea, shock, cardiac arrest, and death

39
Q

food-dependent, exercise-induced anaphylaxis (FDEIA)

A

A rare distinct form of allergy in which an offending food triggers an IgE-mediated anaphylactic reaction only when the sensitized individual exercises within 2 to 4 hours after eating, or occasionally, before eating the food

40
Q

galactose-alpha 1,3-galactose (“alpha gal”)

A

A delayed anaphylaxis response to mammalian meat (most commonly beef, lamp, pork, bison, buffalo, and venison). It involves IgE antibodies that the individual forms against the galactose-alpha 1,3-galactose oligosaccharide which is typically introduced into the person during bites from ticks, most commonly the lone star tick

41
Q

oral allergy syndrome (OAS)

A

Now more commonly referred to as either pollen-food allergy syndrome or lipid transfer protein syndrome. IgE-mediated reactions characterized by oropharyngeal symptoms of itchy mouth; scratchy throat; swelling of the lips, mouth, uvula, or tongue; and throat tightness

42
Q

pollen-food allergy syndrome (PFAS)

A

IgE-mediated reaction characterized by oropharyngeal symptoms of itchy mouth; scratchy throat; swelling of the lips, mouth, uvula, or tongue; and throat tightness. A milder reaction confined just to the oral cavity. Symptoms are rapid and appear within 5 to 30 minutes after ingestion of the allergen-containing food and most often subside within 30 minutes

43
Q

lipid transfer protein syndrome (LTPS)

A

IgE-mediated reaction characterized by oropharyngeal symptoms of itchy mouth; scratchy throat; swelling of the lips, mouth, uvula, or tongue; and throat tightness. The reaction not only affects the oral cavity but also can become systemic with hives, wheezing, vomiting, diarrhea, and low blood pressure, or even anaphylaxis

44
Q

cross-reactivity

A

Reaction to a protein that is similar to an allergen found in the food one is allergic to

45
Q

latex-fruit syndrome or latex-food syndrome

A

Many people with latex allergies have IgE antibodies that can cross-react with antigens from food, mostly fruits, and cause allergic symptoms. Symptoms vary and may include anaphylaxis

46
Q

systemic nickel allergy syndrome (SNAS)

A

Allergy to the mineral nickel begins as contact dermatitis. Individuals with nickel contact dermatitis can develop a secondary response of eczema or dermatitis when the nickel is present in an ingested food

47
Q

eosinophils

A

Type of granulocyte. Capable of releasing inflammatory mediators

48
Q

Eosinophilic esophagitis (EoE)

A

A gastrointestinal disorder which reflects a Th2 inflammation pattern. Symptoms of EoE vary depending on the age of the person and may include early satiety and inability to manage varied food textures in young children, to reflux-like symptoms and vomiting in school-aged children, and to dysphagia, refusal to eat, and food impaction in teenagers and adults

49
Q

Eosinophilic gastroenteritis (EGE)

A

A gastrointestinal disorder which reflects a Th2 inflammation pattern. Symptoms vary depending on the portion of the GI tract involved, and the localized or widespread infiltration by eosinophils. Abdominal pain and nausea and vomiting are the most frequent presenting symptoms in children and adults. Adolescents may present with growth retardation, failure to thrive, and delayed puberty or amenorrhea

50
Q

step up 2-4-6 food elimination diet

A

This approach begins with two-food elimination and steps up after 6 weeks of strict adherence with no remission. This is done again between the four-food and six-food groups if necessary. This approach usually results in prompt recognition of the majority of responders, reducing the number of endoscopies and costs, and shortening the diagnosis process

51
Q

six-food elimination diet (SFED)

A

The elimination of cow’s milk, wheat/gluten, egg, soy, peanut/tree nuts, and fish/seafood

52
Q

food protein-induced enterocolitis syndrome (FPIES)

A

A non-IgE mediated reaction to food. The major criterion is vomiting 1 to 4 hours after ingestion of a food with the absence of IgE-mediated skin or respiratory symptoms.

53
Q

double-blind, placebo-controlled food challenge

A

Allergen is disguised and given orally and patient monitored for reaction; patient and physician blinded; also tested with placebo. “Gold standard” for allergy testing

54
Q

food protein-induced proctocolitis or proctitis (FPIP)

A

Bloody and mucus-laden stools are seen in an otherwise apparently healthy baby, often about 2 months of age. Common food triggers are cow’s milk protein or soy protein from infant formula and their removal from the infant’s diet usually solves the problem

55
Q

food intolerances

A

Adverse reactions to food that result in clinical symptoms caused by non-immunologic mechanisms including microbial, pharmacologic, GI, metabolic, psychological and behavioral or idiosyncratic

56
Q

diamine oxidase (DAO)

A

An enzyme that when deficient can impact metabolism of histamine

57
Q

histamine-N-methyltransferase (HNMT)

A

An enzyme that when deficient can impact metabolism of histamine

58
Q

tyramine

A

A biogenic amine formed from the amino acid tyrosine that is found naturally in some foods, plants, and animals

59
Q

FAILSAFE diet

A

A diet “free of additives, low is salicylates, amines, and flavor enhancers” designed by the Royal Prince Alfred Hospital in Australia. Intended to be used for the investigation and management of people with suspected food intolerance

60
Q

food and symptom record

A

A record of the time food is eaten, quantity and type of food, and all ingredients if possible, and any symptoms that appear and the time of symtpoms

61
Q

skin-prick test (SPT)

A

A type of immunologic testing. Drops of food extract are placed onto the skin and the skin is pricked with the food extract. The area is observed for development of the classic “wheal and flare” reaction

62
Q

food allergen-specific serum IgE testing

A

Used to identify foods that may be causing allergic response. These tests measure the presence of IgE antibodies sensitized to various allergens

63
Q

component resolved diagnostics (CRD)

A

A useful tool in assessing food allergy. CRD involves testing for IgE sensitized to specific component proteins in foods and not just the whole protein extract

64
Q

elimination diet

A

Entails both an elimination phase and a systematic food challenge or food reintroduction period, is the most useful tool in both the diagnosis and management of adverse food reactions

65
Q

food allergen labeling and consumer protection act (FALCPA)

A

Requires the top allergens to be clearly listed by manufacturers as an ingredient or following the ingredient list on food labels

66
Q

precautionary allergen labeling (PAL)

A

Manufacturers may voluntarily list potential unintended allergens that may be present due to cross contamination in a clear way that does not interfere with the required food list

67
Q

oral food challenge (OFC)

A

Conducted in a supervised medical setting. Foods are challenged one at a time on different days while the person is carefully observed in a medical setting for the recurrence of symptoms

68
Q

dual allergen hypothesis

A

Proposes that allergic sensitization to foods may occur from a disrupted skin barrier early in life, as occurs in infantile eczema

69
Q

atopic march

A

A pattern that describes a process in which atopic disorders progress over time from eczema to asthma to multiple allergic disorders including food allergy

70
Q

allergen immunotherapy (AIT)

A

Aims to provide desensitization in a systemic stepwise process, was first described in the early 1900s. A procedure inducing tolerance to a specific allergen by repetitive administration of small amounts of an allergen, and it has been effective in respiratory allergy and venom hypersensitivity

Medical Nutrition Therapy (39 decks)

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