Unit 17

Question 1

What is the difference between a food allergy and an intolerance?

Answer 1

allergy - involves immune system
intolerance - involves digestive system

Question 2

What are the 3 major forms of food allergen immunotherapy?

Answer 2

1. oral immunotherapy (allergen is eaten)
2. Sublingual immunotherapy (allergen is placed under the tongue)
3. epicutaneous immunotherapy (allergen patch is applied to the skin)

Question 3

What are the top 8 foods that cause allergies?

Answer 3

• nuts
• eggs
• peanuts
• soy
• wheat
• milk
• seafood
• fish

Question 4

What age is the incidence of allergy 6-8% higher?

Answer 4

3 years of age or younger

Question 5

What allergies do kids commonly outgrow?

Answer 5

• cow’s milk
• eggs
• soy

Question 6

If the allergy appears before 3 yrs, what % of children outgrow them?

Answer 6

80%

Question 7

If the allergy appears after 3 yrs, what % of children outgrow them?

Answer 7

33%

Question 8

What is the documented incidence of allergy in adults? Compared to how many people believe they have allergies?

Answer 8

3% compared to 20-30% who believe they have allergies

Question 9

What are the different allergic reactions? What are the % of each?

Answer 9

• skin eruptions, rash, hives (84%)
• upset stomach or intestinal tract, vomiting, cramps, nausea, diarrhea (52%)
• respiratory problems: congestion, runny nose, cough, wheezing, asthma (32%)
• anaphylactic shock (rare)

Question 10

What is anaphylactic shock?

Answer 10

a generalized, all-systems reaction that causes low BP, respiratory and GI distress

Question 11

What allergens most commonly are responsible for anaphylactic shock?

Answer 11

eggs, wheat, milk, soy, nuts (tree nuts cause 30% of the deaths), peanuts (62% of anaphylaxis deaths), seafood, fish

Question 12

What do we use to diagnose food allergies in the clinic? Briefly explain each.

Answer 12

skin test - used to suggest allergies or rule them out
blood test - can be used to look for antibodies to specific allergens (not completely definitive)
medically supervised oral food challenge

Question 13

What is the elimination diet and when is is used?

Answer 13

Used for chronic symptoms
2 parts to the diet:
1. elimination (avoidance phase)
eliminate suspicious foods (1-2 weeks or until symptoms are gone
2. reintroduction (challenge phase)
reintroduce suspicious foods, one at a time and watch for symptoms

Question 14

How does an epipen work?

Answer 14

blue to the sky, orange to the thigh (preloaded syringe of epinephrine)

Question 15

Why do we have more allergies today?

Answer 15

1. Hygiene hyopthesis
2. unhealthy fats (low omega-3)
3. obesity (inflammatory state)
4. vitamin D deficiency (increased allergies in NA)
5. timing of exposure to foods (want to induce oral tolerance)
6. use of topical ointments or lotiosn containing peanut oil in infants (bypasses oral route for tolerance)
7. use of soy formula (cross-reactivity to peanuts)

Question 16

What is a food intolerance?

Answer 16

• involves the digestive system
• are typically dysfunctions where an enzyme is missing
• true intolerances produce predictable reactions

Question 17

What are 3 things that can tigger food intolerances? Briefly explain.

Answer 17

1. constituents of certain foods (red wine, aged cheese)
   - histamine in wine blamed for headaches
   - tyramine (aged cheese,, soy sauce) linked to migraines in sensitive people
2. synthetic compounds added to foods (sulfites, food coloring, MSG)
   - sulfites are great antimicrobials but also affect our tissues adversly, people who are sulfit sensitive may have similar reactions as those with food allergies
   - MSG intolerance is linked to dizzines, sweating, flushing, rapid heartbeat and rining ears
3. Deficiencies in digestive enzymes (lactose intlerance)

Question 18

What are the symptoms, causes and prevalence of lactose intolerance?

Answer 18

symptoms:
- bloating, abdominal discomfort, diarrhea, gas
causes:
- lactase declines with age
- intestinal villi damage from medicines, prolonged diarrhea, malnutrition
prevalance:
- >80% southeast asians
- <10% northern europeans

Question 19

What dietary changes need to be made for lactose intolerance?

Answer 19

• do not need to eliminate milk products entirely
• 1/2 cup can usually be tolerated
• increase intake gradually, take with other foods, spread intake through day
• yogurt and hard cheese better (greek yogurt has less lactose than regular)
• as cheese ages there is less lactose (bacteria uses it)
• lactaid milk, tablets or enzyme drops