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Integrative Nutrition and Pathophysiology > Food Allergy Module 2 > Flashcards

Food Allergy Module 2 Flashcards

1
Q

9 top food allergens

A

Peanuts
Tree nuts
Eggs
Fish
Shellfish
Soy
Wheat
Dairy
Sesame (new)

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2
Q

symptoms of food allergy

A

Itching or swelling in your mouth
Vomiting, diarrhea, or abdominal cramps and pain
Hives or eczema
Tightening of the throat and trouble breathing
Drop in blood pressure

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3
Q

NIAID definition

A

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

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4
Q

immune-mediated reaction to food what cells are involved

A

IgE (antibodies)
Non-IgE (immune cells)
Eosinophils
T cells
Mast cells
Mixed (antibodies and cells)
Should not be confused with INTOLERANCE (unknown or other mechanism)

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5
Q

allergies must be __ with repeat exposure

A

allergies must be reproducible with repeat exposure

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6
Q

allergens are __ or __ and are generally __ and __

A

allergens are proteins or glycoproteins and are generally heat resistant and acid stable

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7
Q

major allergenic foods account for >__% of food allergy
includes __ and __

A

major allergenic foods account for >90% of food allergy
includes egg whites and tree nuts also top 9!

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8
Q

allergies most common in children:
__% outgrow by __ years

A

allergies most common in children: milk, egg, soy, and wheat
50% outgrow by 5-7 years

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9
Q

allergies that persist into adulthood:
__% outgrow

A

allergies that persist into adulthood: peanut, tree nuts, finned fish, shellfish
20% outgrow peanut, 1% outgrow tree nuts

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10
Q

2 treenut cross-reactivities

A

Cashew and pistachio
Pecan and walnuts

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11
Q

cross-sensitization
cross-reactivity
cross contamination

A

cross-sensitization: have antibodies
cross-reactivity: sensitivty to both cow’s milk and goat’s milk
cross contamination: kitchen issue

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12
Q

peanuts are cross-reactive with

A

other legumes: peas, lentils, beans

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13
Q

oral allergy syndrome most common in

A

adults, but seen in kids

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14
Q

clinical features of OAS

A

rapid onset oral pruritus
rarely progressive

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15
Q

epidemiology of OAS

A

prior sensitization to pollens

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16
Q

key foods in OAS

A

RAW fruits and vegetables

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17
Q

cause of OAS

A

cross reactive proteins in pollen and food

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18
Q

how does OAS work only with raw things?

A

allergens are heat sensitive, cooked versions are usually okay

19
Q

birch cross reactivity

A

Apple, carrot, celery, cherry, pear, hazelnut

20
Q

ragweed cross reactivity

A

Banana, cucumber, melons

21
Q

grass cross reactivity

A

Melon, tomato, orange

22
Q

mugwort cross reactivity

A

Melon, apple, peach, cherry

23
Q

clinical history consistent with food allergy

A

Immediate onset
Specific symptoms as above
No history of tolerating consistent prior ingestion
Common food allergens are COMMON

24
Q

clinical history NOT consistent with food allergy

A

Delayed onset
Symptoms NOT as above
GI (more lower than upper), neurologic, behavioral, vague rashes
Recurring hives
Chronic asthma or nasal allergy symptoms Occurring inconsistently
History of tolerating consistent prior ingestion
Has ingested numerous times previously
Not a common food allergen (strawberries, kiwi, tomatoes)

25
Q

recommended tests for allergies

A

Skin prick test
ImmunoCAP-RAST Serum IgE testing
Elimination diet: strict, 2-6 weeks, must reintroduce if no change
GOLD STANDARD = oral food challenge

26
Q

NOT recommended tests for allergies

A

Patch tests
Intradermal tests
Unproven tests (IgG, kinesiology, VEGA, NAET, ALCAT, etc.)

27
Q

ImmunoCAP-RAST testing steps

A
  1. patient’s serum with IgE is added
  2. enzyme-labeled antibodies added
  3. developing agent is added
  4. fluorescence is measured
28
Q

positive ImmunoCAP-RAST test means

A

sensitization

29
Q

ImmunoCAP-RAST test

A
  • Many false positives BAD screening test >50% of people test + for foods they are not reactive to (more common in older children and adults)
  • Moderate sensitivity and specificity (“accuracy”)
    Sensitivity and specificity varies by food
  • Higher levels are more associated with clinically relevant “positive” tests
  • Good negative predictive value
    Be careful of non-IgE food allergy
    = NOT equivalent to a diagnosis of allergy
    USE clinical HISTORY to interpret (aka “pre-test probability”)
30
Q

positive IgE and no symptoms =

A

sensitivty

31
Q

sensitivity process

A

Eat peanuts
Dendritic cells present peanut particles to peanut specific T cells
Th2 cells stimulate B cells to make antibodies specific for peanuts
Peanut specific IgE antibodies bind mast cells and go to recognize peanut, nothing happens

32
Q

positive IgE and symptoms

A

allergy

33
Q

allergy process

A

IgE on allergy mast cells binds peanut protein, releases histamines, causes symptoms

34
Q

management and treatment of allergies

A
  1. strict dietary avoidance
  2. management of acute allergic reactions: epinephrine, benadryl, zyrtec
  3. oral food challenges
  4. immunotherapy
35
Q

avoidance

A
  1. STRICT avoidance
  2. label reading
  3. precautionary allergy labeling (PALs)
    may contain, same facility
36
Q

treating anaphylaxis: epinephrine
dose

A

0.01 mg/kg (max 0.5 mg)

37
Q

treating anaphylaxis: epinephrine
route

A

intramuscular
Higher and quicker peak serum levels compared to subcutaneous

38
Q

treating anaphylaxis: epinephrine
location

A

anterior, lateral thigh (vastus lateralis)
Higher and quicker peak serum levels compared to deltoid

39
Q

treating anaphylaxis: epinephrine
frequency

A

~5-15 minutes (adjusted clinically)

40
Q

treating anaphylaxis: adjunct treatments

A

Antihistamine (H1 and H2 Blockers) NOT FIRST-LINE THERAPY
Slow onset (e.g. 30 minutes)
Helpful for urticaria, angioedema, pruritus
Little effect on blood pressure
Addition of H2 blockade (may improve treatment of cutaneous manifestations)
WILL NOT STOP ANAPHYLAXIS

Adrenergic agents
Inhaled beta-2 agonists may be useful for bronchospasm refractory to epinephrine

Corticosteroids NOT FIRST-LINE THERAPY
May prevent protracted/biphasic course but not proven

41
Q

treating anaphylaxis: adjunct/advanced treatment options

A

Oxygen
Fluid resuscitation
Vasopressors
Glucagon
*Presumptive for epinephrine recalcitrant/beta-blockade
Physical position during anaphylactic shock (unless precluded by vomiting or respiratory distress)
*Recumbent with legs raised
*Case reports of death when raised to upright position (“empty ventricle”)

42
Q

reaction does not indicate

A

allergy

43
Q

what is the main way to diagnose IgE-mediated allergies

A

clinical history

44
Q

pathogenesis of food allergy is

A

still unknown

Integrative Nutrition and Pathophysiology (22 decks)

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