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nutrition > Food Allergy and Intolerance > Flashcards

Food Allergy and Intolerance Flashcards

1
Q

inappropriate immunologic response to antigens in food

A

immediate (IgE) Food Allergy

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2
Q

prevalence of Food Allergy

A

10-11% of the US population

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3
Q

onset of food allergy

A

any age, usually in childhood
15% manifest for the first time as adults

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4
Q

risk factors for food allergy

A

Comorbid atopy
eczema
asthma
allergic rhinitis
other allergic disorders

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5
Q

food allergy is an inappropriate activation of the immune system, mediated by what immunoglobulin

A

IgE

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6
Q

manifestations of food allergy

A
  1. present after even a tiny exposure to the allergen (ingestion, topical, inhaled)
    - very rapid onset - mins-hrs (< 2 hours)
  2. Unpredictable - may vary from one exposure to the next
  3. Severity - ranges from relatively mild to extremely severe or life-threatening
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7
Q

associated with problems digesting or metabolizing food

A

Food Intolerance

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8
Q

prevalence of Food Intolerance

A

15-20% of the US population, if not more

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9
Q

onset of Food Intolerance

A

at any age, including adulthood

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10
Q

risk factors of food intolerance

A

Often have functional gastrointestinal disorders (IBS, functional dyspepsia, others)

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11
Q

food intolerance - if Ig present, more likely to be ___

A

non-IgE, including IgG

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12
Q

manifestations of food intolerance

A
  1. Usually present after exposure to the food, with severity correlating with dose of food ingested
    - manifest up to 72 hr after exposure
  2. Symptoms focus around the GI tract
  3. Typically predictable - similar presentations each time, depending on dose of food
  4. Severity - may be uncomfortable, but usually not life-threatening
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13
Q

most common problem foods for food allergies

A

usually proteins
Typically no difference in varieties that are organic, not treated with antibiotics

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14
Q

MC allergenic foods in the US

A

Peanuts, tree nuts, and fish/shellfish
Other common allergens - wheat, eggs, milk, soybeans, sesame

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15
Q

Over ___ possible food and additive allergens

A

160

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16
Q

some common food intolerances

A

problem foods vary widely
1. Lactose, fructose, gluten, caffeine
2. General carbohydrate intolerance - usually secondary to high-FODMAP foods

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17
Q

9 most common allergens must be listed on food labels if present

A

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

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18
Q

what is Not required to identify if product is at risk for environmental contamination

A

food labels

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19
Q

what were the old guidelines (pre-2008) of allergen exposure.

A
  • avoid exposure to allergens in early life
  • Based off theory that due to low secretory IgA in infants, less antigen would be bound (more absorbed) and therefore could trigger a greater immunogenic response
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20
Q

what are the newer guidelines of allergen exposure

A

no convincing evidence to delay allergen exposure
1. Data suggested delayed exposure actually might increase risk of food allergy
2. May consider delaying/avoiding in select children with high risk for food allergy
- Family history of food allergy
- Strong presence of atopic/allergic disorders
- May also consider hypoallergenic infant formulas, modifying mother’s diet

21
Q

ways for childhood allergen exposure

A
  1. early indirect exposure
    - Having mother eat allergenic foods while pregnant
    - Consuming allergenic foods while breastfeeding
  2. Introduction of allergens for direct consumption
    - Foods made with allergens
    - Mix-in liquids or powders
22
Q

presentation of immediate (IgE) food allergy

A

present from a few minutes to a few hours (usually 2 or less) after exposure to the allergenic food
- Derm - pruritus, flushing, urticaria/angioedema, diaphoresis
- Eyes - conjunctival injection, lacrimation, periorbital edema, pruritus
- Nose - sneezing, rhinorrhea, nasal congestion
- Mouth - oral pruritus, metallic taste
- Upper Airway - hoarseness, stridor, sense of choking, laryngeal edema
- Lower Airway - dyspnea, tachypnea, wheezing, cough, cyanosis
- CV - tachycardia, bradycardia (if severe), arrhythmias, hypotension, cardiac arrest
- GI - N/V/D, abdominal cramping, bloating
- Neuro - sense of impending doom, panic, syncope, dizziness, seizures

23
Q

clinical presentation common in children for food intolerences

A

trend towards cutaneous and GI symptoms

24
Q

clinical presentation common in adults in Immediate (IgE) Food Allergy

A

trend towards respiratory and CV symptoms

25
Q

management for acute food allergy

A

limiting inflammatory response
1. Administration of EPI ASAP
2. Additional therapeutics - steroids, antihistamines, beta-agonists, other supportive care

26
Q

management for chronic food allergy

A

focus on avoiding allergenic food exposures

27
Q

Oral Allergy Syndrome aka ___

A

Pollen-Allergy Food Syndrome

28
Q

what is the MC form of food allergy in adults

A

Oral Allergy Syndrome
Allergens in some foods have similar molecular structure to allergenic pollen proteins
These allergens are heat-labile and acid-labile
Much milder presentation overall

29
Q

pts with Oral Allergy Syndrome usually report a hx of ?

A

seasonal allergies, pollen sensitivity
Initial sensitization is typically to pollen, and patients then experience IgE-mediated cross-reactivity

30
Q

Localized, mild immune (IgE) response

A

Oral Allergy Syndrome

31
Q

s/s of Oral Allergy Syndrome

A
  1. present usually within a few minutes after exposure to the allergenic food
    - Mouth - oral pruritus, swelling of oral structures
    - Upper Airway - hoarseness, laryngeal edema, mild stridor or sense of airway narrowing
32
Q

Oral Allergy Syndrome usually presents after exposure to what?

A

raw fruits and vegetables
Do not have symptoms with same foods if cooked

33
Q

management for Oral Allergy Syndrome

A
  1. Acute Management - usually self-limiting
    - Antihistamines
    - Monitor
  2. Chronic Management - avoiding allergenic foods
    - Antihistamines and other methods to control underlying allergic condition
    - Eating cooked versions of foods
  3. May for work-up of more serious allergic disorder if…
    - Symptoms are present after tree nut or peanut exposure
    - Systemic symptoms are present
34
Q

disorder characterized by inability to digest lactose, a milk sugar, due to deficiency of the enzyme lactase

A

Lactose Intolerance

35
Q

what tolerance is actually considered normal for adult mammals

A

Lactose Intolerance

36
Q

what is the Most common enzyme deficiency - >50% of adults worldwide are deficient

A

Lactose Intolerance

37
Q

at what age does natural levels of lactase often decline

A

5 y/o

38
Q

what is the ethnic ties with lactose intolerance

A

Northern European descent - most likely to tolerate lactose well
African, Asian, Mediterranean, Native American - most likely to have lactase deficiency

39
Q

s/s of Lactose Intolerance

A
  1. GI - abdominal pain, bloating, flatulence, borborygmi, nausea, diarrhea hours-days after ingestion of lactose-containing food or beverage
    - abd pain - cramp-like, localized to periumbilical area or RLQ/LLQ
    - Children - more likely to have predominant diarrhea; may see bulky, frothy, watery stool
  2. Severity of symptoms varies depending on amount of lactose consumed, presence of other GI comorbidities, patient sensitivity to symptoms
40
Q

how to diagnose Lactose Intolerance

A
  1. clinically; can trial a lactose-free diet to see if symptoms improve
    - Stool Studies - increased stool osmotic gap and decreased stool pH due to undigested lactose that becomes fermented by gut bacteria
    - Hydrogen Breath Test - patient consumes solution containing lactose and serial breath samples are measured for hydrogen content
    - Small Bowel Biopsy - can be performed during endoscopy to measure presence of lactase enzyme
41
Q

tx for lactose intolerance

A

focuses on minimization of lactose in diet
1. Dietary Lactose Restriction - equivalent of 2 cups of milk/day or less
- Increasing numbers of products with less lactose content
2. Calcium / Vitamin D Supplementation
- To avoid nutritional deficiency
3. Lactase Enzyme Supplementation - may try, but variable results

42
Q

protein found in many cereal grains
Wheat, rye, barley, triticale, malt, brewer’s yeast, wheat products (spelt, semolina, farina, etc.)

A

gluten

43
Q

Non-Celiac Gluten Intolerance is how common? (%)

A

13%

44
Q

Gluten-Sensitive Enteropathy (Celiac Disease) is how common?

A

1% of US

45
Q

what intolerance
Historically found predominantly in patients of European descent
Increasing prevalence in multiple ethnic and racial groups
North Africa, Middle East, India, Northern China

A

gluten intolerance

46
Q

s/s of gluten intolerance and celiac disease

A
  1. GI - abd pain, bloating, flatulence, borborygmi, nausea, diarrhea hrs-days after ingestion
    - Diarrhea - bulky, foul-smelling, floating stools due to steatorrhea
    - Malabsorption - wt loss, anemia, nutritional deficiencies (B vitamins, D, calcium)
    — MC with Celiac Disease
  2. Oral - atrophic glossitis, angular cheilitis
  3. Skin - itchy papules (dermatitis herpetiformis)
  4. Neuro - headache, peripheral neuropathy, epilepsy
  5. Psych - depression, anxiety
  6. Heme - iron deficiency anemia, hyposplenism
  7. MSK - osteomalacia, osteopenia, increased fracture risk
47
Q

how to diagnose Gluten Intolerance and Celiac Disease

A

can trial gluten-free diet to see if symptoms improve
1. Gluten Intolerance - dx of exclusion (no + serum or biopsy tests)
2. Serum Antibody Assay - serum antibody panel may be positive in patients with celiac disease
- advised to keep gluten in diet until panel is performed
3. Small Bowel Biopsy - can be performed during endoscopy to demonstrate atrophy of intestinal mucosa in patients with celiac disease

48
Q

tx for Gluten Intolerance and Celiac Disease

A
  1. Dietary Counseling
    - Consider dietician consult or social services
    - Re-challenge with gluten not recommended
  2. Repeat Testing - Monitor serum celiac-related antibodies for response to therapy
    - Controversial as to whether repeat small bowel biopsy
    - Atrophy of intestine does tend to improve the longer a patient avoids gluten
  3. Supportive Care - pneumococcal vaccination, repletion of nutritional deficiencies
  4. Gluten Enzyme Supplementation - may try, but variable results
    - Not widely recommended, esp with celiac disease

focuses on elimination of gluten from the diet

nutrition (12 decks)

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