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S4 Immune > Food Allergy > Flashcards

Food Allergy Flashcards

1
Q

Define allergic rhinitis/ hay fever

A

Blocked/ runny nose
Itchy nose
Sneezing
Triggered: pollen, pets, HDM

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2
Q

Define allergic conjunctivitis

A

Red, swollen, itchy, watery eyes

Can occur with allergic rhinitis

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3
Q

Define asthma

A

Chest symptoms wheeze/ cough/ shortness breath/ tight chest

Not always allergic

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4
Q

Define atopic dermatitis/ eczema

A

Commonest chronic inflammatory skin disease

Itch and excoriation

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5
Q

What is urticaria (hives)?

A

Acute/ chronic (+-6w) macula-popular pruritus rash without or with angioedema

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6
Q

Different categories of insect allergy

A

Often bee or wasp

Mild - local
Moderate - urticaria
Severe - anaphylaxis

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7
Q

What is allergic conjunctivitis?

A

Red, swollen, watery, itchy eyes

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8
Q

Compare the prevalence of food allergies in children and adults

A

Children 6%

Adults 2%

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9
Q

Why is the most common food allergy in infants? When does it present?

A

Milk
2-3%
Always presents by 12months
Symptoms can present many weeks after first ingested

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10
Q

Two types of presentation of milk allergies

A

Immediate onset - IgE mediated 40%
Allergy symptoms affecting skin, respiratory and GI tracts
Urticaria, cough, wheeze, vomiting, diarrhoea. Can cause anaphylaxis and be fatal

OR

Delayed onset - non-IgE mediated 60%
Multiple GI symptoms
Difficult to diagnose - younger presentation similar to colic, reflux

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11
Q

14 major food allergens

A 
Celery
Cereals contains gluten 
Crustaceans
Eggs
Fish
Lupin - in flour
Milk 
Molluscs
Mustard 
Nuts
Peanuts
Sesame seeds
Soya
Sulphur dioxide (sulphites)
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12
Q

Define allergy

A

Not a disease but mechanism leading to disease
Immunological hypersensitivity can lead to variety of different diseases via different pathomechanisms with different approaches in diagnosis, therapy, prevention can be IgE mediate dor non-IgE mediated

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13
Q

Define allergen

A

Any substance stimulating production IgE or a cellular immune response, usually a protein/ can carbohydrate

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14
Q

Hypersensitivity define

A

Abnormally strong response to a stimulus

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15
Q

Define sensitisation

A

Production IgE antibodies detected by serum IgE assay or skin prick test after repeated exposure to an allergen

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16
Q

Define atopy

A

Tendency produce IgE antibodies in response to ordinary exposure to potential allergens
Strongly associated: asthma, rhinitis, eczema and food allergy

17
Q

Define anaphylaxis

A

Serious allergic reaction with bronchial, laryngeal and CVS involvement
Rapid onset and can cause death

18
Q

What is a food?

A

Substance intended for human consumption including drinks and any substance used manufacture, prep or treatment of food

19
Q

Food intolerance meaning

A

Adverse responses to foods doesn’t involve immune response

20
Q

Food allergy presentation IgE mediated vs non IgE mediated. Symptoms onset, common foods, presenting age, natural history

A

IgE: immediate 5-30mins, milk/ eggs/ peanuts/ tree nuts/ fish/ shellfish/ fruit/ veg, age of contact, all milk allergies by 1 yr, pFS (f&v) in adolescence, milk/ eggs can resolve, others persist

Non IgE - delayed hrs- days, milk/ soya/ wheat/ rice/ oats, infancy and early childhood, resolve earlier than IgE- many by school age

21
Q

Symptoms in IgE and non IgE mediated allergies skin

A

IgE: skin - pruritus, erythema, acute urticaria/
angioedema

Non-IgE: priorities, eczema, atopic eczema

22
Q

Symptoms in IgE and non IgE mediated allergies GI

A

IgE- angioedema, oral pruritus, colicky abdo pain

Non IgE: food refusal/ aversion, abdo pain, infantile colic, gastro-oesophageal reflux disease, loose/ frequent stools, blood/ mucus stools, constipation, perianal redness, pallor, tiredness, faltering growth + GI symptoms +/- eczema

23
Q

Respiratory and CVS symptoms IgE and non IgE

A

IgE: blocked/ runny nose, sneeze, itch, wheeze, cough, DIB

Pallor, drowsy, hypotension

Non-IgE: none

24
Q

What is food associated exercise induced anaphylaxis?

A

Food triggers anaphylaxis only if ingestion if followed temporally within 2hrs by exercise

25
Q

What is pollen food syndrome?

A

Pruritus and mild oedema confined to oral cavity uncommonly progressing, associated with hay fever

26
Q

What is protocolitis

A

Passage bright red blood in mucous stools in otherwise asymptomatic infants

Milk breastfeeding

27
Q

What is enterocolitis

A

Multiple/ varying GI symptoms include feed refusal, persistent vomiting, abdo cramps, loose/ frequent stools, constipation

Milk eggs wheat

28
Q

What is eosinophilic oesophagitis

A

Symptoms oesophageal inflammation and scarring of feeding disorders, reflux symptoms, vomiting, dysphagia, food impaction

Milk eggs wheat

29
Q

What is food protein induced enterocolitis

A

Primary infants

Profuse vomiting leading pallor, lethargy, possible shock, diarrhoea

Milk soya rice wheat meat

30
Q

High food allergies tend to present in infancy, early childhood and adolescence?

A

Infancy - milk, eggs, peanuts

Early childhood - soya, wheat, tree nuts, fish, shellfish, kiwi, sesame

Adolescence - fresh fruit and veg

31
Q

How can temperature and food matrix effect allergies? Why?

A

Heating, baking, boiling, canning
Can reduce allergens in some ppl, e.g. 70% milk allergic can tolerate baked milk, same with egg

Food processing destroys conformational (folded) epitopes

32
Q

Give examples of cross- reactive food allergens

A

Cows milk - 92% react goats milk

Tree nut - 37% react other tree nuts

Fish - 50%

Shellfish - 75%

Pollen - 55% react fruit and veg

33
Q

Steps of evaluating a child with possible food allergy

A

Medical history - context, symptoms, food considerations

Physical exam - manifestations, deferential diagnosis, other allergic conditions

Screening test - IgE mediated FA: skin prick, blood specific IgE. IgE and non: elimination diet

Diagnosis verification - controlled oral food challenges

34
Q

Essential elements of a medical history in suspected food allergy

A 
Age of onset
List of all foods suspected
Route of exposure
Activity at time (exercise/ alcohol)
Intercurrent illness (mimic)
List of foods previously ingested without symptoms 
All symptoms & severity
Timing symptoms 
Duration 
Treatment provided 
Manner food prepared 
Minimal quantity of food required to cause symptoms
35
Q

How is a typical immunoassay for detection to specific IgE carried out?

A

Allergen absorbed and immobilised to solid phase
Patients serum added -> incubation 30-60mins -> washing steps -> allergen bound IgE detected by enzymatically labelled anti-human IgE monoclonal antibody

Most commonly used: ELISA-plates, western blots, strips, immunoCAP, microarrays

36
Q

How can you detect IgE?

A

Serum specific IgE - circulating in blood

OR

Skin prick tests - response mast cells

Determine presence of sensitivity

Level of sIgE/ size SPT correlates with likelihood of allergy (positive predictive thresholds developed for common allergens)

S4 Immune (7 decks)

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