Nutrition

Question 1

What is the difference between food allergy and food intolerance?

Answer 1

Food allergy - immune mediated

Food intolerance - not immune mediated

Question 2

What are the 2 types of food allergies?
Describe the speed of reaction of both?
How are both diagnosed?

Answer 2

IgE

• acute and rapid response
• skin prick/specific IgE antibody tests

Non-IgE (thought to be ?T cell mediated)

• delayed and non-acute response
• 2-6 weeks elimination and then re-introduce food and observe reaction

Question 3

Name 4 dermatological presentations of food allergens/ food intolerances

Answer 3

Both

• erythema
• pruritus

IgE

• acute angioedema (swelling - in particular of face e.g. lips n eyes)
• acute urticaria (hives)

Non-IgE
- atopic eczema

Question 4

Prevalence of food allergy in children under 3?

Answer 4

6-8%

Question 5

What skin conditions can be exacerbated by obesity?

Answer 5

Increased testosterone levels due to increased subcutaneous fat

• hirstusim
• acne
• Androgenetic alopecia (balding pattern in men and women)
• Hidradenitis suppurativa (chronic condition where boils form and scar in apocrine glandular areas e.g. axillae and groin)

Increased insulin resistance

• Acanthosis nigricans (darkened patches of skin)
• Skin tags (usually in neck and axillae)
• Stretch marks
• poor venous return
• increased risk of skin infections
• intertigo (macerated red plaques which form due to increased friction and high moisture levels)
• psoriasis (cause unknown)

Question 6

What are two v important questions regarding history in food allergies?

Answer 6

• Speed of onset

- Reproducibility of symptoms on repeated exposure

Question 7

How long is “immediately” after ingesting?

Answer 7

Seconds - 2hrs

Question 8

Contrast eczema vs urticaria

Answer 8

Urticaria

• Well defined
• White/erythematous
• Smooth surface

Eczema

• poorly defined
• erythematous
• scaly surface

Question 9

Describe treatment pathway for acute allergic reaction

Answer 9

1. Chlorphenamine (if asthmatic give inhaler too)

If doesn’t resolve or gets worse in 30 mins

• phone 999/ go to A&E
  2. Give oral prednisone

If goes blue/collapses
3. Adrenaline IM

Question 10

What childhood food allergy is much more likely to be lifelong?

Answer 10

Peanut (grow underground)

Question 11

How long should a child with an allergy to cows milk protein (CMA - cow’s milk allergy) withdraw from cows milk?

Answer 11

9-12 months of age

for at least 6 months

Question 12

Children with food allergens are more likely to be underweight. True or false?

Answer 12

True

Question 13

What kind of milk should be prescribed if baby has CMA allergy?

Answer 13

Extensively hydrolysed milk

Question 14

Lymph-oedema in obesity, what does it lead to and what causes it?

Describe the appearance

Answer 14

Leads to cellulitis

Increased fat -> poor lymphatic drainage -> swelling -> chronic inflammation -> poor oxygenation -> bacterial overgrowth -> cellulitis

Question 15

What is pellagra and what is it caused by?

How does it present?

Answer 15

Defiency of B3 (niacin) - in people with v limited diets/ high grain-low protein

4D's
Dermatitis - bilateral, red, itchy symmetrical rash which is worse on sun exposed areas
Delirium
Diarrhoea
Death