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(C) Nutrition > Lecture 11: Food Allergies and Intolerance > Flashcards

Lecture 11: Food Allergies and Intolerance Flashcards

1
Q

What is a food allergy?

A

Inappropriate immunologic response to antigens in food, specifically IgE.

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2
Q

When do most allergies appear?

A

Childhood

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3
Q

What is food intolerance?

A

Problems digesting or metabolizing food

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4
Q

What are the primary risk factors for food intolerance?

A

Functional GI disorders
* IBS
* Functional dyspepsia
* Others

Generally gets worse the more they eat

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5
Q

What are the shared symptoms between food allergies and intolerance?

A
  • Nausea
  • Diarrhea
  • Vomiting
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6
Q

What are the most common allergens in the US?

A
  • Peanuts
  • Tree Nuts
  • Fish/Shellfish
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7
Q

What foods/substances are people usually intolerant of?

A
  • Lactose
  • Fructose
  • Gluten
  • Caffeine
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8
Q

What is the US legal requirement when it comes to allergen listing? What is not required?

A

The 9 most common allergens must be on the food label if they are present.

However, not required to label if it is at risk of contamination.

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9
Q

What are the current guidelines in regards to early chilldhood allergen exposure?

A

DO not delay exposure.
Only select children may need delaying, such as strong family Hx or atopic disorders.

New guidelines came out in 2009.

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10
Q

What are the various ways children can be exposed to allergens?

A
  • Mother eats allergenic foods while pregnant or breastfeeding.
  • Foods mixed with allergens or powders.
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11
Q

What kind of IgE symptoms do children tend to have? Adults?

A

Children: Cutaneous and GI
Adults: Respiratory and CV

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12
Q

How do we treat suspected IgE food allergy mediated reactions?

A

Epinephrine is a MUST for acute management. It can result in a higher risk of death as it is delayed.

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13
Q

What is oral allergy syndrome?

A

Pollen-allergy food syndrome.
MC type of food allergy in adults.

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14
Q

How can we help someone eat pollen allergens?

A

They are heat and acid labile, so cooking them tends to alter the allergen.

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15
Q

What history suggests oral allergy syndrome?

A
  • Seasonal allergies
  • Pollen sensitivity
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16
Q

Describe the response of someone with oral allergy syndrome.

A

Localized, mild immune (IgE) response.
* Mouth: oral pruritis, swelling of oral structures
* Upper airway: hoarseness, laryngeal edema, mild stridor or sense of airway narrowing

17
Q

When does an oral allergy response typically occur?

A

Eating raw fruits or vegetables, but no symptoms if they are cooked.

18
Q

How do we manage oral allergy syndrome?

A
  • Acute: Antihistamines
  • Chronic: Avoid and antihistamines
19
Q

What is the MC enzyme deficiency in the world?

A

Lactase deficiency

20
Q

What country tends to have the least lactose intolerance?

A

Northern europeans

21
Q

What tests can we run to check for lactose intolerance?

A
  • Stool studies: increased osmotic gap, low pH
  • Hydrogen breath test
  • Small bowel biopsy: measure lactase enzyme
22
Q

How do we treat lactose intolerance?

A
  • Less than 2 cups of milk daily
  • Calcium/Vit D supplementation
  • Lactase enzyme supplement
23
Q

What is gluten? What is the primary grain it is found in?

A

A protein found in grains, primarily wheat!

24
Q

What are the two conditions associated with gluten?

A

Non-celiac gluten intolerance (13%)
Gluten-sensitive enteropathy (celiac disease)

25
Q

What ethnicity generally has higher rates of gluten intolerance or celiac?

A

Europeans

26
Q

What kind of diarrhea do gluten intolerance/celiac present with?

A
  • Bulky
  • Foul-smelling
  • Floating/steatorrhea
27
Q

What is unique about gluten intolerance/celiac?

A

Multi system manifestations.

  • HA
  • Seizures
  • Depression
  • Iron deficiency anemia
  • Osteomalacia, osteopenia
28
Q

What is the common rash seen in celiac/gluten intolerance?

A

Dermatitis Herpetiformis

29
Q

How do we diagnose celiac or gluten intolerance?

A
  • Gluten intolerance: dx of exclusion
  • Serum antibody assay (for celiac, but advised to keep eating gluten until test is performed)
  • Small bowel biopsy (atrophy of intestinal mucosa in celiac)
30
Q

How do we treat gluten intolerance or celiac disease?

A
  • Dietary counseling (Avoid gluten, do not rechallenge.)
  • Repeat testing (monitor antibodies)
  • Supportive care (Pneumococcal vaccine, nutritional supplements)
  • Gluten enzyme supplementation (variable results, not recommended in celiac patients)

(C) Nutrition (12 decks)

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