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Food Allergy

Food Allergy. Dr. Amal Kokandi (MB,BCh, MSc, MD) Assistant professor, Consultant dermatologist April 2010. Good news.

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Food Allergy

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  1. Food Allergy Dr. Amal Kokandi (MB,BCh, MSc, MD) Assistant professor, Consultant dermatologist April 2010

  2. Good news • The largest observational study so far to examine the association between chocolate consumption and risk of cardiovascular disease has found that those who ate the most chocolate--around 7.5 g per day--had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate (1.7 g per day). (German Institute of Human Nutrition, Nuthetal, Germany) Buijsse, B, Weikert C, Drogan D et al. Chocolate consumption in relation to blood pressure and risk of CV disease in German adults. Eur Heart J 2010: DOI:10.1093/eurheartj/ehq068. Available at: http://eurheartj.oxfordjournals.org.

  3. Adverse reactions to food

  4. IgE mediated food allergy • Quick onset • Reproducible • Typical symptoms • Typical foods • Positive tests

  5. Epidemiology • Self reported ranges from 3-35% • Oral food challenges (OFCs) proved ranges from 1-10-8% • More than 20% of adults & children alter their diet because of perceived belief of averse reaction to food or allergy

  6. Symptoms The most common food allergy symptoms include: • Tingling in the mouth • Hives, itching or eczema • Swelling of the lips, face, tongue and throat, or other parts of the body • Wheezing, nasal congestion or trouble breathing • Abdominal pain, diarrhea, nausea or vomiting • Dizziness, lightheadedness or fainting

  7. Anaphylaxis • Constriction and tightening of airways • A swollen throat or a lump in your throat that makes it difficult to breathe • Shock, with a severe drop in blood pressure • Rapid pulse • Dizziness, lightheadedness or loss of consciousness • anaphylaxis can cause a coma or death.

  8. Other forms of food allergy • Exercise-induced food allergy • Pollen-food allergy syndrome or oral allergy syndrome • Latex associated food allergy (banana, avocado, kiwi, papaya and apricot) • Note: latex can induce delayed type hypersensitivity • PARTIAL LIST: Band-Aids, rubber bands, erasers, some shoes and articles of clothing, balloons, surgical gloves, catheters, condoms, some items of sporting equipment , blood pressure cuffs, some watch bands, helmets, tooth brush massagers, bowling balls and ventilator tubing

  9. Diagnosis • History • +associated conditions • Allergy testing • Skin prick testing (commercial and fresh food) • Serum specific IgE • Oral food challenge (open and blinded)

  10. Allergy testing • Suspected allergens • Common allergens • Common associations • Egg and peanut • Milk and soy • Peanut with sesame, tree nuts and lupin • Cross sensitisation and common reactivity • Not to miss contamination • Do not test if tolerated

  11. Major allergens (FDA required labeling) • Cow’s milk • Egg • Wheat • Peanut • +Sesame and kiwi • Soy • Tree nuts (such as almonds, cashews and walnuts) • Fish (bass, cod and flounder) • Shellfish (crab, lobster and shrimp)

  12. Management • Allergen avoidance • Consider other allergens • Dietetic education • Supplementations • Food labelling • Hidden allergens

  13. Management • Recognition & treatment of reactions • Education and follow up • antihistamines • Adrenaline autoinjectors and labels • Severity of previous reaction, presence of bronchial asthma, peanut allergy • Co morbidities • Follow up

  14. Problems with avoidance • Total avoidance • Labeling • Hidden allergens

  15. Hidden allergens • Tooth paste • natural fruit extracts such as citrus and strawberries • Arachis oil (peanut), coconut, sesame & tree nut oils • Wheat, oat, barly • Makeup • wheat, sesame oil, soy • Medications, vitamins & supplements • Lactose, starch, glucosamine products in shellfish allergies (made from oyster or other shell fish) • Hair products • Wheat, citrus oil, mushroom oil, almond, soy.. • Adhesives • Wheat (envelope and stamp licking)

  16. Impact of food allergy diagnosis • Risk of fatal reactions • Quality of life worse than type I DM • Risk of compromised nutrition, dietary advise is crucial, supplementation • Shopping and social events • Economical problems

  17. Web sites of interest • World allergy organization site • www.worldallergy.org • Food allergy & anaphylaxix network • www.foodallergy.org • Mayo clinic web site • www.mayoclinic.com • About.com • www.about.com

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