Food Allergy or intolerance Flashcards
Neo-natal nutrician. How much milk should neonates have in the first few days of life and how often should they fees?
How much milk (Breast fed babies tend to be accounted for by the length of the feed)
• D1 = 60ml/kg/d
• D2 = 90ml/kg/d
• D3=120ml/kg/d
• D4=150ml/kg/d • How often
• 3-4 hours (so divide the whole day worth of feed by 6 or 8) • Which route
• Bottle/Breast/NGT
What types of formula milks are available?
• OTC
Types of milks
• Term formula – Whey or casein based, Soy based
• Many other commercially available products – comfort, hungry baby, lactose-free
• Prescription only
• Pre-term formula (energy dense)
• Extensively hydrolysed formulae (used for dairy intolerance)
• Elemental formula (severe food intolerance)
• MCT rich formula (malabsorption due to bowel resection, liver disease)
when should Weaning occur?
• 4-6 months
Weaning
• May require specialised weaning regime if clinical diagnosis of food product intolerance e.g. dairy
Advantages of breast feeding
- Anti-infective properties
- Humoral
- IgA – mucosal protection
- Bifidus factor – promotes growth of lactobacillus to help digest lactose • Lysozyme – bacteriolytic enzyme
- Lactoferrin – inhibits growth of E.coli
- Interferon – antiviral
- Cellular
- Macrophages
- Lymphocytes
- Nutritional
- Protein – whey:casein 60:40
- Lipid – rich in oleic acid
- Fat – enhanced lipolysis
- Calcium:phosphorus – promotes calcium absorption • Low renal solute load
- Iron – bioavailable
- Long-chain polyunsaturated fatty acids
Complications/disadvantages of breast feeding
- Unknown intake
- Transmission of infection – CMV, Hep B & HIV • Transmission of drugs
- Vitamin K deficiency
- Transmission of misuse of drugs
- Emotionally demanding at times
What is the result of Severe protein-calorie malnutrition
- Marasmus
- Muscle wasting, no oedema
- Kwashiorkar
- Generalised oedema, muscle wasting, weight loss may not be severe • Depigmented hair, desquamation of skin, abdominal distension
- Marasmic-kwashiorkar
Management (WHO – 10 steps) for malnutrition in children
- Treat hypoglycaemia
- Treat for hypothermia
- Treat for dehydration
- Treat electrolyte disturbance
- Treat infection
- Treat micronutrient deficiency • Initiate feeding
- Rehabilitation
- Achieve catch-up growth
- Provide sensory and emotional support • Follow-up
What is Rickets and what causes it?
- Failure in mineralisation of the growing bone
- Causes
- Nutritional rickets
- Intestinal malabsorption
- Defective production of Vit D2 – liver disease • Defective production of D3 – kidney disease
Signs and symptoms of rickets, how is it diagnosed?
- Signs & symptoms
- Craniotabes, Rachitic rosary, swollen wrists and ankles, Harrison’s sulcus
- Diagnosis
- Dietary history
- Bloods – low/normal calcium, low phosphorus, high Alk Phos, raised PTH, low vitamin D
- Management - Supplementation
Complications of obesity in children
• Complications • Orthopaedic–SlippedUpper Femoral epiphysis • Idiopathicintracranialhypertension • Sleepapnoea • Non-alcoholic fatty liver disease • Type2diabetesmellitus • Hyperlipidaemia • Psychological issues
Define hypersensitivity vs allergy
hypersensitivity - objectively reproducible symptoms following exposure to a defined stimulus at a dose tolerated by normal people
Allergy – hypersensitivity reaction initiated by specific immunological mechanism
Define intolerance
Intolerance – Non-immunological hypersensitivity reaction to specific food
Define atopy
tendency to produce IgE antibodies in response to ordinary exposures to potential allergens. Strong association with asthma, allergic rhinitis and conjunctivitis
What is the “Allergic salute”
rubbing an itchy nose
Which components of allergy diagnosis are IgE mediated ?
IgE mediated
•Skin Prick test
•RAST tests
•Mast cell tryptase
Non IgE mediated
•History
•May require endoscopy
•Exclusion (gold standard)
