Food Allergies and Intolerance

Question 1

Common causes

Answer 1

food additives, preservatives, colorings.

Question 2

How to test

Answer 2

1. skin prick, skin scratch: of little value
2. measuring circulating antigen-specific immunoglobulin concentrations: May be more effective.
3. suspected offending food item withdrawal followed by replacement may be most effective method of identifying the cause.
4. Dysbiosis should be considered.
5. The presence of food sensitivities should be identified, offending foods should be avoided.
   -severely affected: May require hydrochloric acid or pancreatic enzymes.

Question 3

Food Allergies Etiology

Answer 3

Allergy Reaction:
a. IgE- mediated (immediate hypersensitivity)
b. Mixed IgE and non IgE mediated (hypersensitivity).
c. Cell mediated delayed hypersensitivity

Inflammation: Release of Inflammatory mediator

Anaphylaxis:
a. GI cutaneous, Respiratory and Systematic symptoms

Question 4

IgE- Mediated (immediate hypersensitivity)

Answer 4

-Oral allergy syndrome: results from direct contact with food allergen and confined mostly to oropharynx.
-Reaction to food-is result of presence of food antigen with structure similar to pollen
-It causes itching, irritation of oral tissues and swelling/blisters within 30 min.
-Seen in individuals with coexisting seasonal allergic rhinitis to birch, ragweed, grass, pollens following ingestion of specific fruits, vegetables or nuts.
-Nutrition intervention:
-cooked fruits and vegetables
-Elimination diet

Question 5

Immediate GI hypersensitivity

Answer 5

-Immediate GI hypersensitivity
-Develops within mins to 2 hours after ingestion of an offending food
-Includes nausea, vomiting, diarrhea and abdominal pain
-IgE dependent and independent mechanism involving mast cells, esophagitis.
-Nutrition intervention: comprehensive elimination diet

Question 6

Non IgE mediated-mixed antibody reactions

Answer 6

-antibody complex can cause food related inflammatory disease which includes various forms of colitis, enteritis with bleeding, malabsoptive disorders, ulceration, chronic pneumonitis.
-Non IgE mediated antibody reactions involves celiac disease, protein losing enteropathies, eosinophilic esophagitis, eosinophilic gastroenteritis and ulcerative colitis.
-Multiple components of immune system are involved.
-NUtrition intervention:
a. assessment of nutrition status
b. food and symptoms diary
c. comprehensive elimination diet
d. exclude food antagonist
e. Education on avoidance of food allergens
-personalized supplementation including vitamins, minerals, prebiotics, probiotics and glutamine to optimize GI function.

Question 7

Food Intolerances

Answer 7

-Caused by non-immunologic mechanisms including toxic, pharmacologic, metabolic, and idiosyncratic reactions.
-Symptoms caused by food intolerances are often similar to food allergies and include GI, cutaneous and respiratory symptoms.

Question 8

Food Intolerance (examples)

Answer 8

A. Enzyme deficiencies
a. lactose foods with lactose
b. glucose - 6phosphate dehydrogenase fava and broad beans
c. fructose food containing sucrose and fructose.

Diseases
a. Cystic fibrosis high fat food, certain proteins.
b. GB disease high fat foods
c. Pancreatic disease eating

Neurological reactions
a. precipitated by any food

Reactions to pharmacological agents in food
a. phenylethylamine
b. Tyramine
c. Histamine
d. Histamine releasing agents

Reactions to additives
a. Tarazine or FD & C yellow no 5
b. Benzoic acid or sodium benzoate, BHA, BHT, nitrates
c. Monosodium Glutamine (MSG)

Question 9

Food Intolerance MNT

Answer 9

-Assessment of nutrition status
-keep food and symptoms diary
-food- elimination diet
- Total avoidance of offending food
-personalized supplementation including vitamins, minerals, prebiotics, probiotics, and glutamine to optimize GI function.
-Education on avoidance of food allergens.