hypotension, dysrhythmias, anaphylaxis are all symptoms of what type of food allergies?
systemic
Most common food allergens
milk
eggs
peanut and tree nuts (almond, cashews, pecans)
soy
wheat
fish
shellfish
Food allergens are most commonly foods with
high protein content
Risk factors for food allergies
heredity-->atopy
GI permeability (malnutrition, celiac, chrons [damage to the SI])
environmental factors (pollution)
microflora imbalance
To diagnose a food allergies you must:
1. identify the suspected food
2. prove that the food causes an adverse reaction
3. verify that it is an immune response and not a food intolerance
description of symptoms
time of food ingestion relative to the onset of symptoms
list of suspected foods
quantity of food required to cause a reaction
does ingesting the suspected food produce the same symptoms on a different occasion
family history
Are all part of...
clinical history
In the physical examination you wanna check for
signs of malnutrition, growth problems, weight loss/gain related to avoidance of food or restricting calories
Skin-->atopic ezcema, uticaria (hives)
performed to rule out non-allergenic causes of symptoms
What you need to track in a food and symptom diary
list all food and beverages specifically (type, quantity of food, time consumed) for 1-2 weeks
document time of onset and severity of symptoms
*if reactions occur less frequently-->24 hour recall
The purpose of ____ is to help to identify suspect food(s), reveal hidden sources of the allergen and assess the nutritional adequacy of the diet and identify deficiencies
food dairies
Laboratory tests used to detect IgE antibodies in the blood directed against the suspected food
Used to confirm an immunologic mechanism
Example: skin prick, CAP-FEIA
Immunologic testing
Cheap, easy and common immunologic testing
Can be inaccurate (false positive, 50% of all pos. results are accurate)
Skin prick
immunologic test that mixes blood with allergen and look for IgE
used when anaphylactic or have bad skin disease and can't do skin prick
96-100% accurate for milk, wheat, eggs, fish and peanuts
86% accurate for soy
CAP-FEIA
A personalized eating plan that omits all forms of the suspected food(s) for 4-12 weeks in order to determine if symptoms improve/resolve with total avoidance
Food-Elimination diets
If multiple food are suspected in the food-elimination diet then....
....more strict elimination diet is needed
After symptoms resolve after a food elimination diet, foods are are returned _____
one by one
______ can be use to provide supplemental nutrition on a very strict elimination diet
Elemental formulas
These are drinks that have proteins that are hydrolyzed to free amino acids
They are expensive, not well accepted and reserved for the most severe cases
Examples: Neocate, EleCare
elemental formulas
Tested used to confirm a food allergy after symptoms have resolved
Food are reintroduced one at a time on a different days in a medical setting and are monitored for symptoms
Neither the patient or clinical is aware if it is the suspect food or placebo
Double-bind placebo-controlled food challenge
Treatment of a food allergy
only proven treatment is total avoidance of the food allergen
Requires manufacturer to state on product label if any of the big 8 allergens are contained in the food
(milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soy)
Food allergen labeling and consumer protection act of 2004
Protects against food allergies, but doesn't eliminate the risk
for infants at high risk of allergy--> exclusively THIS for at least 4 months is recommended
Breastfeeding
While an infant avoid feeing solid foods until ____ of age
4-6 months
For infants at high risk, a partial or extensively ____________ is recommended to replace cow's milk formula
hydrolyzed infant formula
Immune compounds in ____ are beneficial for infants
breast milk
If allergic to cow's milk formula and unable to use breast milk use_____
hydrolyzed formula
Ex. Nutramigen
True/False: use a soy formula if baby is allergic to cow's milk
False!
if allergic cow's milk, can develop an allergy to soy
Immunomodulatory factors being investigated for prevention of food allergies (all for pregnant mother's diet)