Week 1 - D - Food allergy (brief), skin tags/acanthosis nigricans, vitamins, marasmus/kwashiorkor

Question 1

A food allergy is what occurs when there are symptoms caused by an immune reaction to food eg nuts What are food allergies usually but not always mediated by?

Answer 1

Food allergies are usually but not always mediated by IgE

Question 2

What describes a non-immune reaction to food resulting in symptoms? Give an example condition of this

Answer 2

A non-immune reaction to food resulting in symptoms is known as a food intolerance ie lactose intolerance - there is a deficiency i the lactase enzyme leading to poor breakdown of lactose in the GI tract - excess unabsorbed lactose results in symptoms

Question 3

What hormone found in peripheral fat stimulates sebaceous glands? Which sweat gland’s fluid production is dependent on this?

Answer 3

Hormone found in peripheral fat stimulating sebaceous glands is known as androgen The aprocrine glands which produce an oily secretion which causes an odour after bacterial decomposition is androgen dependent

Question 4

How does obesity increase the rates of acne?

Answer 4

Obesity causes an increase in the peripheral fat in the body which leads to an increase in androgen production - this causes sebaceous glands to become more active leading to an increase in sebum production and hence oily skin leading to acne

Question 5

What are two skin conditions that are related to an increased insulin resistance?

Answer 5

This would be skin tags and acanthosis nigricans

Question 6

What are skin tags and what is thought to be the cause of them? What is usually the treatment?

Answer 6

A skin tag is a benign outgrowing of the skin - it is thought to be caused by skin rubbing against skin and is therefore more common in such areas eg the neck, armpits and groin Usually no treatment is required however for cosmetic reasons, they may be excised by a professional

Question 7

What is acanthosis nigricans? Where does it usually occur?

Answer 7

Acanthosis nigricansis the name given to a skin condition characterised by a velvety thickening and hyperpigmentation of the skin usually in the armpit, neck or groin (skin folds)

Question 8

What is thought to be the pathophysiology of acanthosis nigricans? What conditions is it common in?

Answer 8

It is most common in patietns who are obese Other causes include eg type 2 diabetes The condition occurs due to endocrine dysfunction where there is an increased insulin resistance. The increase in circulating resistance activates receptors on keratinocytes and fibroblasts increasing their proliferation

Question 9

What is the treatment of acanthosis nigricans?

Answer 9

Treat the cause of the condition ie if obese, then lose weight If diabetic, then treat the diabetes If Cushing’s, then treat the excess glucocorticoid

Question 10

What is the rare cutaneous manifestation diabetes that is seen on the anterior shins of diabetic patients? Does the diabetic control correlate with the progression of this?

Answer 10

The condition is known as necrobiosis lipoidica The control of diabetes does not correlate with the progression of this condition

Question 11

Describe the appearance of necrobiosis lipoidica?

Answer 11

Often asymptomatic or tender The plaques may persist for years. They may be round, oval or an irregular shape. The centre of the patch becomes shiny, pale, thinned, with prominent blood vessels (telangiectasia).

Question 12

What is the condition known as where there is increased hair in females in a male area eg chin or upper lip? What is this due to?

Answer 12

Hirsituism due to elevated levels of androgens

Question 13

If results show that there is an IgE mediated food allergy, how do you test for this?

Answer 13

Test for this by 1. Skin prick testing 2. Serum specific IgE testing

Question 14

How do you test in non IgE mediated food allergy?

Answer 14

trial elimination of the suspected allergen usually for 2-6 weeks and then reintroduce after the trial

Question 15

Vitamins can either be classed as water-soluble or fat-soluble vitamins What are the examples of both?

Answer 15

Water soluble vitamins - * The 8 B vitamins and vitamin C (vitamin B1, B2, B3, B5, B6, B7, B9, B12 and vitamin C) Fat soluble vitamins * Vitamin A, D, E and K

Question 16

Let’s now discuss different vitamins Which vitamin is essential for helping vision in low light and colour vision, epithelial proliferation, keratinisation and development?

Answer 16

This would be vitamin A

Question 17

B vitamins include vitamin B1, B2, B3, B5, B6, B7, B9, B12 What are vitamin B1, B2, B3, B6, B9 and B12 also known as?

Answer 17

Vitamin B1 - thiamine Vitamine B2 - riboflavin Vitamin B3 - niacin Vitamin B6 - pyridoxine Vitamin B9 - folate Vitamin B12 - cobalamin

Question 18

What is a symptoms of vitamin B2 deficiency?

Answer 18

Stomatitis -inflammation of the mouth and lips Angular stomatitis - inflammaiton of the corners of the muth

Question 19

What is vitamin B3 deficiency known as? What are the 4Ds?

Answer 19

Pellagra Dermatitis, Diarrhoea, Dementia, Death

Question 20

What is a sign of vitamin B6 deficiency? Which drug can cause it?

Answer 20

Vitamin B6 deficinecy -causes peripheal neuropathy Can be caused by izoniazid treatment - eg for TB (give isoniazid with pyroxidine)

Question 21

What percentage of the worlds children are affected by protein energy absorption? What are the two types?

Answer 21

one third of the worlds children are affected by protein energy absorption Two types are marasmus and kwashiorkor

Question 22

What is the difference between marasmus and kwashiokor?

Answer 22

It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein.

Question 23

What is the difference between the clinical presentations of children with marasmus (protein and calory deficiency) and kwashiorkor (protein deficiency)?

Answer 23

Marasmus - children present with prominent bones and severe muscle wasting and a voracious appetite Kwashiorkor - children present with oedema and ascites, and a fatty liver

Question 24

What is the prevalence of food allergy in children?

Answer 24

6-8% have the disease

Question 25

What are the two most common food allergies in children?

Answer 25

Allergy to cow’s milk and eggs

Question 26

What are the symptoms of a food allergy in a child?

Answer 26

Symptoms of a food allergy can affect different areas of the body at the same time. Some common symptoms include: an itchy sensation inside the mouth, throat or ears a raised itchy red rash (urticaria, or “hives”) swelling of the face, around the eyes, lips, tongue and roof of the mouth (angioedema) vomiting

Question 27

If a child had a cow’s milk allergy, what formula could be prescribed?

Answer 27

Extensively hydrolysed formula (Nutramigen LIPIL 1)

Question 28

Which GI disease is dermatitis herpatiformis related to? Is this a food allergy or a food intolerance? What is the type of diet used to manage it?

Answer 28

Coeliac disease This is a food allergy Use a lifelong gluten free diet (no barley, rye, wheat)

Question 29

Deficiency in what vitamin results in hyperkeratosis around hair follicles, inflamed gums and poor wound healing?

Answer 29

Vitamin C deficiency