Food Allergies - Exam 2

Question 1

What is the prevalence of a food allergy? When is it most likely to show up?

Answer 1

Roughly 10-11% of the US population

usually in childhood, but 15% will show up as adult

Question 2

What is the physiology behind a food allergy?

Answer 2

Inappropriate activation of the immune system, mediated by IgE**

Question 3

**What antibody specifically mediates a food allergy?

Answer 3

IgE

Question 4

______ inappropriate immunologic response to antigens in food

______ associated with problems digesting or metabolizing food

Answer 4

Food allergy

food intolerance

Question 5

Food intolerance are prevalent is about ____ % of the US population. What is a risk factor?

Answer 5

15-20%

other GI disorders

Question 6

Food allergy or intolerance is more likely to present in adulthood? What antibody is responsible?

Answer 6

food intolerance

more likely to be non-IgE, including IgG

Question 7

What is the normal manifestation for a food intolerance?

Answer 7

symptoms based on severity correlating with dose of food ingested

GI s/s, may be uncomfortable but NOT life threatening

Question 8

Food allergies are usually _____ in nature. What are the 3 MC? What are some additional ones?

Answer 8

protein

MC: Peanuts, tree nuts, and fish/shellfish

wheat, eggs, milk, soybeans, sesame

Question 9

Name some common food intolerances?

Answer 9

Lactose, fructose, gluten, caffeine

Question 10

**What are the 9 US legal requirements that must be listed on food labels

Answer 10

Peanuts, tree nuts, fish, shellfish, wheat, eggs, milk, soybeans, sesame

Question 11

T/F: Only the processing line has to be “GF” in order to put GF on the label.

Answer 11

FALSE, the ENTIRE facility has to be GF to put that on the label

Question 12

What is the early childhood allergen exposure recommendation?

Answer 12

exposure children to all the things, do NOT wait, could increase risk of developing food allergy

Question 13

What are some common signs of IgE food allergies?

Answer 13

pruritis, urticaria/angioedema, oral pruritus, sense of choking, wheezing, cough, nausea/vomiting, diarrhea

Question 14

Children experiencing IgE food allergies trend towards ____ and ____ symptoms. Vs adults trend towards ____ and ____ symptoms

Answer 14

Children - trend towards cutaneous and GI symptoms

Adults - trend towards respiratory and CV symptoms

Question 15

What is the management of IgE food allergies?

Answer 15

epinephrine ASAP!!

can add on: steroids, antihistamines, beta-agonists,

Question 16

What is the MC form of food allergy in adults? What else will they report?

Answer 16

Oral Allergy Syndrome - aka Pollen-Allergy Food Syndrome

Allergens in some foods have similar molecular structure to allergenic pollen proteins

Patients typically report history of seasonal allergies, pollen sensitivity

Question 17

**Describe the oral allergy syndrome? What are ways to mediate this response?

Answer 17

Localized, mild immune (IgE) response!

cook the foods! s/s are decrease if present at all

Question 18

What are some key distinguishing factors for oral allergy syndrome? Name some s/s

Answer 18

Usually present after exposure to RAW fruits and vegetables. Do not have symptoms with same foods if cooked

Symptoms are restricted to oral area in about 98% of patients

Mouth - oral pruritus, swelling of oral structures
Upper Airway - hoarseness, laryngeal edema, mild stridor or sense of airway narrowing

Question 19

What is the management for oral allergy syndrome?

Answer 19

avoid allergenic foods

Antihistamines may be helpful (Benadryl, Ranitidine)

COOK the foods!!

Question 20

When would you want to work a pt up for a more serious food allergy?

Answer 20

Symptoms are present after tree nut or peanut exposure

Systemic symptoms are present

Question 21

____ is the MC enzyme deficiency. At what age does the bodies natural level of lactase decline? What ethnicities?

Answer 21

Lactose Intolerance

About 5 years of age - natural levels of lactase often decline

African, Asian, Mediterranean, Native American

Question 22

What ethnicity CAN tolerate lactose well?

Answer 22

Northern European descent

Question 23

How is lactose intolerance more likely to show up in children?

Answer 23

more likely to have predominant diarrhea; may see bulky, frothy, watery stool

Question 24

Lactose intolerance dx is often made _____. What tests can you order to confirm?

Answer 24

clinically!

stool studies
hydrogen breath test
small bower bx

Question 25

What will the stool studies show of a pt with lactose intolerance?

Answer 25

increased stool osmotic gap and decreased stool pH due to undigested lactose that becomes fermented by gut bacteria

Question 26

How does the hydrogen breath test work?

Answer 26

patient consumes solution containing lactose and serial breath samples are measured for hydrogen content

Question 27

How does a small bowel bx work when trying to confirm lactose intolerance?

Answer 27

can be performed during endoscopy to measure presence of lactase enzyme

Question 28

Non-Celiac Gluten Intolerance is present in up to ___ of US pts. Celiac Disease is present in about ___ of US populations. What ethnicity?

Answer 28

13%

1%

North Africa, Middle East, India, Northern China

Question 29

Describe the diarrhea in pt with gluten intolerance/celiac dz?

Answer 29

often bulky, foul-smelling, floating stools due to steatorrhea

Question 30

What are some additional s/s that are commonly associated with celiac dz?

Answer 30

weight loss, severe anemia, nutritional deficiencies (B vitamins, D, calcium)

Question 31

T/F: Gluten Intolerance and Celiac Disease
only present with GI symptoms

Answer 31

False! can present with extra-intestinal manifestations

Question 32

What is dermatitis herpetiformis? What intolerance is it associated with? What is a way to dx it?

Answer 32

looks like herpes bumps but pathology is not correct. Raised, bumpy appearance on the arms and legs

Gluten Intolerance and Celiac Disease

can do a Tzansk smear and it will show that it is NOT herpes (no giant nucleated cells)

Question 33

What is the best way to dx gluten intolerance?

Answer 33

gluten free diet trial

serum antibody assay (pts will need to keep eating gluten until after this test is performed)

small bowel bx

Question 34

What vaccination is important for Gluten Intolerance and Celiac Disease pts to have? Why?

Answer 34

pneumococcal vaccination

because of the extraintestinal damage that can occur to the spleen, resulting in varying degrees of functional hyposplenism. Celiac patients have been found to have a 7% higher chance of pneumonia than comparable non-Celiac controls.