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Block 3 Week 8 Meg > Wilson: Pediatric Food Allergies > Flashcards

Wilson: Pediatric Food Allergies Flashcards

1
Q

Adverse food reactions can be classified into two categories. What are they?

A
  1. immunologically-mediated (allergy)
  2. food intolerance (adverse physiologic response to a food or food additive not immunologically mediated) - ex: lactose intolerance
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2
Q

Immunologically-mediated food reactions can be divided into two categories.

A

Disorders mediated by IgE

Non–IgE-mediated mechanisms (which generally take hours to evolve)

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3
Q

Non-immune adverse reactions to foods

A
  1. metabolic (ex: lactase deficiency, fructose intolerance)
  2. pharmacologic (ex: histamine, tyramine, caffeine)
  3. toxic (ex: food poisoning)
  4. other (ex: panic, reflux)
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4
Q

Water-soluble glycoPROTEINS that are heat and proteolysis resistant with molecular weights of 10-70 kd

A

This is what typically causes food allergies

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5
Q

(Blank) of households consider at least 1 family member to have food allergy
The actual prevalence is estimated to be approximately 6% in infants and children and 3.7 % in adults.

A

25-30%

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6
Q

T/F: The incidence of real food allergy starts out high in children and then declines. Between 0-5 y/o, food allergies most common. By age 15, not much incidence whatsoever.

A

True

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7
Q

Examples of mixed (IgE-mediated/non-IgE mediated) food reactions.

A

atopic dermatitis (excesma)
eosinophilic esophagitis/gastroenteritis
asthma

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8
Q

Non-IgE mediated food reactions

A

celiac disease (immunologically mediated, but not mediated by IgE)

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9
Q

Most common mechanism of food hypersensitivity

A

IgE mediated

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10
Q

IgE antibodies produced to specific (blank) of the food allergen
Antibodies bind to high-affinity IgE receptors on basophils and mast cells present in skin, GI tract, and respiratory tract

A

epitopes

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11
Q

Subsequent allergen exposure binds two adjacent IgE antibodies resulting in receptor (BLANK) and initiating the release of histamine, prostaglandins, leukotrienes, chemotactic factors, and cytokines
Vasodilatation, smooth muscle contraction, and mucus secretion, which are responsible for the spectrum of clinical symptoms observed

A

cross-linking

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12
Q

IgE is very specific to the (blank), and upon second exposure will produce a very immediate reaction.

A

allergen

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13
Q

IgE Mediated – Immediate usually within hour of ingestion
Urticaria, angioedema, difficulty breathing, wheezing, hypotension, oropharyngeal pruritus, angioedema, stridor, dysphonia, cough, dyspnea, nausea, vomiting, diarrhea, flushing
“Sense of impending doom”
Fatalities result from severe laryngeal edema, irreversible bronchospasm, refractory hypotension, or a combination.

A

food anaphylaxis

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14
Q

Food allergy has been confirmed in approximately (blank) of patients with anaphylaxis presenting to the emergency department.

A

1/3

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15
Q

Most common cause of food-induced anaphylactic reactions

A

peanuts, tree nuts, shellfish

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16
Q

asthma, especially with poorly controlled disease
previous episodes of anaphylaxis with the incriminated food
failure to recognize early symptoms of anaphylaxis
a delay or lack of immediate use of emergency medications to treat the allergic reaction

A

risk factors for fatal food anaphylaxis

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17
Q

Will Benadryl stop anaphylaxis?

A

No – may lead to delayed use of epinephrine and delay going to the hospital

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18
Q

Patients develop itching or tingling lips, tongue, palate, and throat following the ingestion of certain foods
Edema of the lips, tongue, and uvula and a sensation of tightness in the throat may be observed

A

pollen-food allergy syndrome

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19
Q

What causes pollen-food allergy syndrome?

Give an example.

A

cross-reactivity between certain pollen and food allergens; ex: exposed to ragweed pollen and then eat a banana, ex: exposed to grass pollen and then eat a melon

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20
Q 
Immediate test for hypersensitivity-IgE
Can read 20 minutes after placement
Quick, convenient, inexpensive
False positive rate for foods is high (>50%)
Itching
Blocked by antihistamines
A

Allergy Prick testing

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21
Q

This measures serum IgE against foods - no need for patient cooperation (just uses serum) - no effects from antihistamines - false positive rate very high (70%)

A

RAST testing

22
Q

Problems with testing for food allergies

A
  1. must always be based on the history

2. skin testing to foods without history is likely to cause problems

23
Q

IgG RAST is (blank)

A

worthless

24
Q

This type of allergy test has delayed hypersensitivity - you read the test after 48-72 hours - can’t bathe - great for nickel allergy - provides minimal data for foods

A

allergy patch testing

25
Q

This is an observed incremental challenge - needed when there are questions about diagnosis - takes several hours - must be prepared with epinephrine and crash cart

A

food challenges

26
Q

A severe, cell-mediated GI food hypersensitivity typically provoked by cow’s milk or soy.
Symptoms delayed – onset of vomiting, diarrhea, and lethargy/dehydration
May also be due to grains, veggies, poultry.

A

food-protein induced enterocolitis syndrome (FPIES)

27
Q

Initial presentation was severe in 79% of the patients
57% prompted sepsis evaluations
64% hospitalization for dehydration or shock.
Diagnosis of FPIES was delayed, after a median of 2 reactions
High degree of suspicion for diagnosis
Patch testing has provided some useful information

A

More on FPIES

28
Q

What is the outcome and conclusion of the FPIES study?

A

Most patients outgrew cow’s milk and soy intolerance at age 20 and 14 months.
First FU-OFC should be performed with soy at 6-8 months of age and cow’s milk at over 12 months of age.

29
Q

Increasingly common disease seen in infants, children, adolescents, and adults.
Symtoms: FTT, vomiting, GI reflux, food impactions
Requires high index of suspicion
Management requires cooperation of GI and primary care.

A

eosinophilic esophagitis

30
Q

Eosinophilic esophagitis is analogous to (blank) - both are eosinophilic diseases, response to steroids, chronic, strongly associated with allergies
No PFT equivalent for EE.

A

asthma

31
Q

Prevalence of (blank) allergy is highly significant in patients with atopic dermatitis (eczema)

A

egg
< 2 years: egg (39.22%)
2 to s milk (35.13%) and egg (32.43%)
6 to 14 years: peanut (25%) and egg (16.67%)

32
Q

What is the only proven medical therapy for food allergies?

A

elimination and strict avoidance

33
Q

Treatment of food allergies

A

strict elimination/avoidance
epinephrine injectors/training
education

34
Q

(blank) is of paramount importance for patients with food allergies

A

education

35
Q

Treatment for patients with eosinophilic esophagitis?

A

First, trial of specific food allergen avoidance
If unsuccessful, try an elemental diet
Systemic corticosteroids could work (prednisone)
Topical corticosteroids (MDI fluticasone, budesonide slurry)
Allergy shots

36
Q

What percent of patients with eosinophilic esophagitis can improve both symptoms and esophageal inflammation with dietary elimination of foods?

A

75%

37
Q

What was the conclusion of the oral viscous budesonide and children study?

A

topical viscous budesonide is a safe and effective therapy for eosinophilic esophagitis in young children

38
Q

Conclusions from the peanut oral immunotherapy protocol in children with peanut allergy

A

Subjects were more likely to have significant allergic symptoms during the initial escalation day when they were in a closely monitored setting than during other phases of the study. Allergic reactions with home doses were rare.

39
Q

Results of milk oral immunotherapy study

A

Before treatment, all children had symptoms after a median challenge dose of 40 mg of milk.
After milk immunotherapy, the lowest milk dose to cause a reaction was 1340 mg, likely to be protective against the overwhelming majority of accidental exposures.
Post-treatment food challenge still elicited reactions in 14 of 18 children

40
Q

Food allergy can be (blank) mediated non-(blank) mediated

A

IgE

41
Q

Food induced (blank) is common

A

anaphylaxis

42
Q

What determines the type of tests used?

A

history

43
Q

Indiscriminate (blank) testing is a bad idea

A

RAST

44
Q

Epinephrine injectors require (blank)

A

training

45
Q

Eosinophilic Esophagitis presents in various ways depending on (blank)

A

age

46
Q

(blank) can be severe, is under appreciated, non-IgE mediated

A

FPIES

47
Q

(blank) is essential for treatment but desensitization looks promising

A

avoidance

48
Q

T/F: Food allergy is associated with atopic dermatitis

A

true

49
Q

Most accurate food allergy test

A

food challenge

50
Q

Is FPIES IgE mediated?

A

No

Block 3 Week 8 Meg (8 decks)

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