Allergic Reactions Ebook

51 Ways to Reduce Allergies

51 Ways to Reduce Allergies

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Allergy Relief

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Anaphylaxis And Acute Allergic Reactions

Anaphylaxis, a term used inconsistently in the literature, is a severe systemic hypersensitivity reaction characterized by either hypotension or airway compromise that is potentially life threatening in nature and that is caused by chemical and IgE mediators released from mast cells. Anaphylactoid was coined to describe responses clinically identical to anaphylaxis that were found to be non-IgE mediated and that did not require a sensitizing exposure. 1 Recent work has shown that the final pathway in classic anaphylactic and anaphylactoid reactions is identical, and anaphylaxis is now used to refer to both IgE and non-IgE reactions.2 Hypersensitivity is an exaggerated immune system response to presented antigens. Anaphylaxis lies at one end of a gradient of hypersensitivity reactions, and it is important to keep in mind that even apparently mild allergic reactions may progress to severe anaphylaxis.

Hypoallergenic milk formulae7

According to the definition of the European Scientific Committee for Food, hypoallergenic or hypoantigenic formulae are those which contain hydrolysed protein. The peptides of HF should be as short as possible. In extensively hydrolysed formulae (eHF) 95 of peptides have a molecular weight below 1500 dalton and less than 0.5 of the remaining peptides are above 6000 dalton. Partially hydrolysed formulae (pHF) have 2-18 of peptides above 6000 dalton. These larger peptides may elicit allergic reactions. pHF have a higher capacity to induce positive skin tests and provocation tests and to bind to the human serum IgE antibodies of children allergic to cow's milk. Amino acid-based formula does not have peptides so there is no likelihood of allergic reactions. ELISA inhibition assay, with polyclonal antibodies specific for casein components of cow's milk, is a sensitive method for estimating residual antigenicity in hypoallergenic infant formulae, suggesting their potential application for...

Clinical categorisation of allergic reactions

In a series of 62 adults and children with peanut allergy, Ewan18 divided patients into those whose separate symptoms were Out of the 62 patients, 20 had skin changes only, 33 had evidence of airway involvement with laryngeal oedema or wheezing, and nine had evidence of a significant fall in blood pressure.18 The categorisation of laryngeal oedema is discussed below. Contact symptoms are common in food-related allergic diseases, especially in children and those with irritated or inflamed skin diseases such as eczema. These symptoms are very rare in people with food intolerance, and most adults (99 ) with the syndrome of chronic urticaria (bouts of intermittent episodes of itchy hives and swelling that last longer than 6 weeks) do not have food allergy.19 Sicherer et al.20 showed that in 102 individuals with peanut allergy, the first reaction is characterised by isolated skin reaction in 49 , by respiratory reaction only in 2 , by both skin and respiratory in 17 , by both skin and...

The Food and Chemical Allergy Association

The Food and Chemical Allergy Association, based at 27 Ferringham Lane, Ferring, West Sussex BN12 5NB, came into being as a result of a letter sent to a daily newspaper in 1976 by its founder, Ellen Rothera. She had been ill for eight years and came to believe that food allergies due to a malfunctioning immune system were the root cause. She managed to stabilise her condition and make a recovery. Ellen's letter to the Daily Express was not only published, but given a leading position. As a result she was inundated with letters and telephone calls from people desperately seeking answers to their own medical conditions. A small group gathered for a meeting and formed an association, which set out to find doctors with knowledge of allergy, learn from them and continue in a self-help role. A committee was formed and a secretary appointed to answer all enquirers. The FCAA continued in this manner for some years but eventually its role was changed to that of an advisory service. Today the...

Treating the immediate symptoms 551 Acute allergic reactions to foods

Development of symptoms within two hours of ingestion of the suspected food may be reasonably classified as an acute reaction. These reactions are commonly due to milk, egg, fish and nuts (Table 5.6). The person may or may not know the food responsible. In children, allergic reaction may occur to the first known exposure to a food such as cow's milk, egg or peanut. It may also develop in an adult to a food previously well tolerated although this is uncommon. Acute allergic reactions are usually IgE mediated. Allergic reactions occur as a result of interaction of allergen with IgE antibodies bound to receptors on the surface of mast cells. This interaction results in the release of mediators such as histamine, heparin, bradykinin, prostaglandin and leukotrienes. The allergen may come from a variety of sources such as foods (e.g. peanut), drugs (e.g. penicillin), insects (e.g. bee venom), etc. The reaction may involve one or more systems and may be mild, moderate or severe. The severity...

Determining the safety and efficacy of hypoallergenic infant formulas

Hypoallergenic protein hydrolysates to be used as an ingredient in infant formulas of high nutritional and therapeutic value should be rich in low molecular weight peptides, especially di- and tripeptides, with the least quantity possible of free amino acids. Sometimes it is difficult to know the composition of hydrolysates because of a large number of possible constituents, due mainly to potential degrees of polymerisation of the peptides, and several analyses may be done to assess their suitability. In addition to degree of hydrolysis, in vitro characterisation of peptide size and determination of allergenicity are valuable for quality control of the products and assurance of batch to batch consistency as well as for labelling. However, on the basis of the current knowledge, such data do not predict the immunogenic or the allergenic effects in the recipient infant, and the safety and efficacy of HA infant formulas can only be determined by clinical trials using scientifically...

OAS and pollen allergy

The frequency with which OAS occurs in subjects with pollen allergy is notable. Up to 40 of subjects with birch and ragweed allergy suffer OAS.15 Ragweed allergy is particularly associated with reactions to bananas and melons, and birch allergy with celeriac, apple and hazelnut allergens. The basis of the latter is thought to be homology between the relevant allergens, particularly Bet V 2 from birch, Mal d 1 from apple, and Bet v1 and Apig 2 from celeriac.16 Treatment of pollen allergy with immunotherapy has abrogated associated OAS reactions.17

Food Intolerance and Allergy

According to some surveys, 20 to 25 of people in the U.S. are allergic to certain foods. Self-reported information based on changes in dietary habits to accommodate a food problem is likely to be mostly erroneous. Often, patients who say they have a food allergy avoid a food and never seek medical advice. Diagnosis of food allergies is overworked, poorly defined, and misused. There are many misconceptions about food allergies, such as understanding of the causes of food allergies and their symptoms. A minority of practitioners who have overemphasized the magnitude of the role of food allergies in human illness have greatly contributed to this misconception. The American Academy of Allergy and Immunology has sharply criticized their concepts and questioned their practices. Double-blind placebo-controlled studies indicate that food allergies occur in 2 to 2.5 of the population. It has been estimated that 1 to 3 of children under the age of 6 years have allergies to foods. The frequency...

The British Allergy Foundation

The British Allergy Foundation has a broad sphere of interest, encompassing all types of allergy. BAF was formed as a registered charity in 1991 by a group of leading medical specialists who were all determined to improve the awareness, prevention and treatment of allergy. The charity is managed by a board of trustees which deals with all the business aspects of the organisation. All decisions on medical and scientific matters in which the foundation is involved are made by a team of medical advisers. These are among the leading allergists in the country and most are members of the British Society for Allergy and Clinical Immunology. The British Allergy Foundation is based at Deepdene House, 30 Bellegrove Road, Welling, Kent DA16 3PY and provides those affected by allergies with information and advice, including details of National Health Service allergy clinics. Leaflets, fact sheets and regular newsletters contain practical and informative articles. BAF also has a helpline (020 8303...

Novel and uncommon food allergies

There are a number of foods that are eaten in geographically or culturally quite specific populations and adverse food reactions are limited to these groups. However, with diversification of cultures and diets across the globe, particularly in developed countries, adverse reactions to these foods may be seen in many other countries. A good example is sesame seed, to which allergy in Western countries was rarely reported (Rance et al. 1999). However, there are reports of an increasing number of cases of sesame seed allergy in France coincident with the increase in Middle Eastern food and fast food bread (Kolopp-Sarda et al. 1997). Sesame seed often causes severe clinical allergy hence its importance. In France sesame seed was responsible for 0.6 of IgE-mediated food allergies seen in recent years in an allergy clinic population (Rance et al. 1999). Table 10.12 makes the point that uncommon food allergens are important causes of food allergy in specific countries. In an Israel allergy...

Mechanisms of food intolerance and food allergy

With regard to underlying mechanisms and trigger factors for food allergy and food intolerance, it is fair to say that our level of knowledge is very much in its infancy. We know, for example, that some individuals are more susceptible than others. Atopy (predisposition to allergic disease) is heritable, so could this What role do food allergens themselves play We know generally that the most common foods implicated in food allergy and food intolerance are egg, milk, peanuts, nuts, fish and soya.5-7 On average, an individual's gastrointestinal tract will process about 100 tonnes of food during a lifetime. Everything we eat is foreign to our body and potentially immunogenic. What is so special about some food allergens Why do only a proportion of people have the ability to sensitise and cause an allergic reaction What is the natural history of food allergy and food intolerance We do not know why with some foods, such as milk, sensitivity is lost with time, while with others, such as...

Commonly reported food allergies 1031 Cows milk

Cows' milk is an important weaning food in many countries. In recent years it has become practically ubiquitous, being found in an increasing range of commercially produced foods (Sampson 1998). There is extensive cross-reactivity between milks of different species (Businco et al. 1995, Carroccio et al. 1999). Cows' milk is one of the first foods to enter an infant's diet and therefore is often the first to cause problems. Adverse reactions to cows' milk can be divided into two main groups, immunological (IgE or non-IgE mediated) or non-immunolo-gical (Host et al. 1997, Host and Halken 1998). This latter group is mainly due to lactase deficiency and may be difficult to differentiate clinically from non-IgE mediated cows' milk allergy (Host et al. 1997, Bruinjzeel-Koomen et al. 1995). Cows' milk allergy gives rise to a spectrum of disease from immediate symptoms ranging from urticaria to anaphylaxis (Goldman et al. 1963, Sampson et al. 1992) and late symptoms which may not develop for...

Gesundheit and gnight The multiple responses to allergies

Some cells in the immune system cause the release of histamines, chemicals that cause the sneezing, runny nose, hives, itching, fatigue, and other symptoms of allergies. Histamines can also cause constriction of the bronchials (tubes that feed air into the lungs) that lead to the wheezing in asthma. In severe reactions, this tightening of the breathing tubes can be life-threatening. In addition to the redness, warmth, and swelling in the area, the cytokines and pressure on the nerve endings in the tissue cause pain. Check out the sidebar, Gesundheit and g'night The multiple responses to allergies, for more symptoms of allergies. If allergies and the body's response to them sounds just like the immune system and endometriosis, you're right In both cases the immune system is responding to seemingly harmless foreign matter (endometrial cells or irritants such as pollen) in a way that wreaks havoc on the body. The association is strong Many women with endometriosis also have multiple...

Fish and Shellfish Allergies

Seafood is a common source of food allergies. About 250,000 Americans experience allergic reactions to fish and shellfish each year. People with seafood allergies can have symptoms that range from mild to life-threatening. Even tiny amounts of fish substances can trigger a reaction in some people. What's more, these allergies are rarely outgrown. Examples of shellfish that are common causes of allergic reactions include shrimp, crab, lobster, oyster, clam, scallop, mussel, and squid. Fish that can trigger allergic reactions include cod, salmon, trout, herring, sardine, bass, tuna, and orange roughy. Symptoms of an allergic reaction include nasal congestion, hives, itching, swelling, wheezing or shortness of breath, nausea, upset stomach, cramps, heartburn, gas or diarrhea, light-headedness, or fainting. If you suspect that you have any food allergies, see an allergist for a careful evaluation. This generally includes a medical history, physical examination, and skin or blood testing....

Severe allergic reactions

This can be quite dramatic, with erythema and rash all over the body surface, and swelling of the face, lips and tongue. However, if confined to the skin and oral mucosa, it is usually not life-threatening. This reaction responds to oral or parentral antihistamine in addition to corticosteroids. Treatment may need to be continued for a few days until symptoms have completely subsided. Unless the cause of the reaction is known, the patient should be referred to an allergy clinic for evaluation.

Diagnosis of drug allergy

Allergic reactions to drugs must be distinguished from similar clinical phenomena of different causes. Two forms of immunologic diagnosis then must be made identification of the specific cause of the reaction, and identification of the immunopathologic Table 1 Clinical classification of allergic reactions to drugs

Igemediated Food Allergies

In IgE-mediated food allergies, allergen-specific IgE antibodies are produced in the body in response to exposure to a food allergen, usually a protein. These IgE antibodies are highly specific and will recognize only a specific portion of the protein that they are directed against. Occasionally, IgE antibodies produced against one particular protein in a specific food will confer sensitivity to another food either because the food is closely related or because it shares a common segment with the allergenic protein. Some food proteins are more likely to elicit IgE antibody formation than others. Although exposure to the food is critical to the development of allergen-specific IgE, exposure will not invariably result in the development of IgE antibodies even among susceptible people. Many factors, including the susceptibility of the individual the immunogenic nature of the food and its constituent proteins the age of exposure and the dose, duration, and frequency of exposure, are...

Drug Treatment in the Management of Food Allergy

At present, drug treatment has little part to play in the management of food allergies. There are two exceptions. First, there are a very small number of cases in which the reaction to a food is exclusively gastrointestinal, and in whom the reaction can be blocked by taking the drug sodium cromoglycate by mouth 20min before the trigger food is swallowed. Second, there are a small number of individuals who develop the life-threatening reaction, of anaphylactic shock when exposed to a trigger food. There are three ways in which anaphylactic shock may prove fatal. First, rapid swelling of the soft tissues in the pharynx may completely obstruct the airway the treatment is to bypass the obstruction, either by passing an endotracheal tube, or by performing a tracheostomy. Another mechanism is severe shock, with a profound drop in blood pressure the life- saving treatment is to restore the circulating volume with intravenous fluids and to give oxygen. The third mechanism is severe...

Prevention of allergy

There is general consensus that the prevalence of asthma and other atopic diseases, including food allergies, is increasing. A history of allergic disease in the immediate family (atopic heredity) is the most important risk factor. Recent studies indicate that exposure to allergens in utero and in the first few months of life is critical in the development of allergic disease in children with an atopic heredity. In children at high risk, reduction in exposure to allergen should lead to a decline in disease prevalence. Food proteins are important allergens in early childhood. A hypoallergenic diet has therefore been suggested as a means of preventing the development of allergy. Experimental evidence indicates that the child can be sensitised in utero. It is sometimes advised that an atopic mother should avoid highly allergenic foods during pregnancy. However, there is concern that this might adversely affect the growth of the foetus. Avoidance of allergens during early infancy has been...

Foods that commonly cause allergy

Foods that can give rise to allergic reactions in susceptible individuals appear to be diverse in nature. However, although reactions to many different foods have been described in individual case reports, the list of common causal agents is relatively short. This has led researchers to postulate that there may be certain features characteristic of food allergens. Common causes of allergy are milk, egg, peanut, tree nuts, fish, shellfish, soy and citrus fruits for populations in the UK and the USA. The list can vary for different countries for example, Mediterranean countries such as Italy have a high incidence of sensitivity to olives, and in Japan even sensitivity to birds' nest soup has been described. To be capable of inducing an allergic reaction a food must contain substances that are immunogenic, and give rise to allergic sensitisation. This results in the production of IgE antibodies in preference to IgG and T cells of the Th2 phenotype rather than the Th1 phenotype. On...

Mediators and nasal allergy

Mediator release after nasal airway challenge with allergen has now been extensively investigated. Nasal lavage for the recovery of secretions on the surface of the nasal mucosa has made it possible to identify a postallergen challenge increase in a vast number of putative mediators of inflammation in humans. As well as experimental provocation tests, the inflammatory response of the nasal mucosa to natural exposure to pollen can also be measured. Much can be learned about the immediate (early) phase and the late (delayed) phase reaction so that a hypothesis can be generated of the involvement of different trigger cells during the different parts of the allergic reaction (Figure 1). It would seem that mast cells arc the main source of histamine in the early phase, and basophils the main (but lesser source) in the late phase, during which there is no similar increase in prostaglandin D2. During the pollen season there is a large increase in the number of nasal mast cells, but perhaps...

Evolution of allergic reactions

Two of the most important features that distinguish allergic reactions associated with allergen-specific IgE are the rapid onset of symptoms, usually within 5-10 minutes of exposure to foods, and the gradual resolution in the course of one or two hours. Most mild to moderate reactions occur within this time frame. Mild to moderate reactions are generally defined as reactions confined to the skin or gastrointestinal tract, while severe reactions are those that threaten the airway or cause a fall of blood pressure. It can be very difficult in most subjects to predict when a reaction is becoming so severe that treatment must be initiated. Severe reactions can gradually evolve from relatively minor symptoms and can form a second phase of response once the initial symptoms have resolved, or they can gradually develop slowly and persist for considerable periods of time. This variation in the presentation of severe symptoms needs to be specifically sought in the history. Most reactions that...

Interpreting data on the natural history of food allergy

Cohort studies have been very successful in delineating the natural history of allergies to foods such as cows' milk and egg because they are almost completely outgrown within a few years. For longer lived allergies, such as fish, shellfish, peanut and tree nuts, the natural history is less clear because of the difficulties in interpreting the available data. This is illustrated by results from an interview survey investigating the prevalence of peanut allergy (Emmett et al. 1999). The data (Figure 10.3) suggest that more males are affected in childhood whereas in adulthood peanut allergy is more prevalent in females. There are a number of possible explanations for these results. Firstly, peanut allergy may be outgrown at an earlier age in males. Secondly, peanut allergy may be acquired later in females. Thirdly, there may be a combination of both of the above. Fourthly, the data may be explained by a cohort effect the adult generation surveyed may have a lower inherent risk of...

The need for hypoallergenic foods

Food proteins are essentially foreign proteins capable of eliciting immunological responses. Any food protein may be allergenic if it can be absorbed intact or as substantial fragments, through the gut mucosa, and then evoke an immune (allergic) response. Some foods, such as rice and vegetables, are less allergenic than others, such as milk, egg and nuts. The intrinsic properties of the protein, the overall composition of the food, and the processing (especially thermal processing) all have an effect on the allergic potential. In the management of food allergy it is possible to exclude the food responsible for symptoms and to replace it with less allergenic foods. In certain situations it is not possible simply to eliminate the food, e.g. milk during infancy. Up to 2.5 of infants are affected by cow's milk allergy (CMA) in the first two years of life, although most of these children will outgrow their reactivity within 2-3 years. However, during the interim period an alternative milk...

Food allergyintolerance

Food allergy in the cat may be associated with concurrent flea bite, inhalant or flea-collar hypersensitivity (White 8c Sequoia, 1989). Food allergy as a disease is a well-recognised cause of feline dermatological problems (Carlotti et al, 1990 Rosser, 1993), the prevalence of which varies from rare to common according to different authors. The pathophysiology of this syndrome is not completely understood. Adverse reactions to food may be either toxic or nontoxic if they are non-toxic they may be either due to intolerance or to immunological (allergic) reactions. Food allergy may be defined as an immunologically mediated excessive reaction to food substances, to be distinguished from food intolerance where enzyme deficiencies, pharmacological factors and toxic reactions, among others, may be implicated. The diagnosis of food allergy is achieved with a diet trial using a source of protein and carbohydrate to which the cat has had no or minimal exposure. This may be home cooked or, more...

Documenting Possible Food Allergies

The diagnosis of food allergy is made from the history, supported by investigations and by responses to avoidance of specific food triggers. Since the value of investigations is limited, it is especially important to obtain a clear history. There are a number of practical points to be made Speed of onset. In general, the quicker the onset of the allergic reaction, the more reliable is the history. If a child develops a violent allergic reaction within a minute or two after ingesting a food, it is much easier to link the reaction to a specific food than if a reaction only occurs hours or days after eating a food. Failure to seek inconsistencies such as these is one factor that is responsible for the overdiagnosis of food allergy.

Oral allergy syndrome

The constellation of immediate symptoms less than one hour after exposure and usually confined to the mouth has been called the oral allergy syndrome (OAS), first characterised in 1987 by Amlott etal.13 The initial group of 36 subjects was broadly divided into those whose symptoms did not progress (50 ) and those who responded to larger doses of allergen, with more severe reactions. For each individual subject the quantity of food required to cause OAS and other symptoms varied.13

Intolerances Allergies to Nuts

Intolerances to nuts, or more specifically, allergies to nut proteins, occur in a relatively small minority of people. However, there is evidence that such adverse reactions have become more common, and the severity of the reaction that occurs in these sensitive individuals means that they must be taken very seriously. Peanuts are the most commonly cited cause of these severe reactions, estimated to affect between 0.1 and 0.2 of the population, but allergic reactions to tree nuts, incuding Brazil nuts, almonds, hazelnuts, and cashews, and also to sesame seeds, have been reported.

Cellmediated Food Allergies

Cell-mediated food allergies are sometimes called delayed hypersensitivity reactions, because the symptoms of these reactions typically appear 6 to 24 hours after consumption of the offending food. Cell-mediated allergies involve the interaction of food allergens with sensitized lymphocytes, usually in the intestinal tract. These reactions occur without the involvement of IgE or other antibodies. The interaction between the allergen and the sensitized lymphocyte results in lymphokine production and release, lymphocyte proliferation, and the generation of cytotoxic T lymphocytes. Lymphokines are soluble proteins that exert profound effects on tissues and cells resulting in localized inflammation. Lymphocyte proliferation increases the number of reactive cells thus magnifying the inflammatory process. The generation of cytotoxic or killer T cells results in the destruction of other intestinal cells including the critical absorptive epithelial cells. The T lymphocytes responsible for...

The practical application of due diligence to food allergenicity

In some cases, the practicalities of factory layout, the range of products and raw materials handled and other factors may make the elimination of cross-contamination unachievable. In such cases clear labelling of the presence of traces which have the potential to provoke an allergic reaction can provide an alternative approach. With products containing nuts the stakes clearly are higher. In this case, consideration should be given to the manner in which the information is communicated. In some instances, the presence of nuts or nut-derived ingredients is essential to provide the authentic characteristics of the product. In this case, merely labelling their presence may not be enough and it may be necessary to emphasise their presence. This may be done by emboldening the nut ingredients in the list of ingredients. Even this may not provide complete peace of mind, as situations have arisen where a consumer allergic to, for example, almonds but not peanuts has innocently purchased a...

Research into allergy and intolerance

Much progress has been made in recent years in understanding the mechanisms of allergy, but our knowledge is far from complete. Despite good work done in the UK and the United States and elsewhere, it is still uncertain how and why some people become allergic to certain foods and substances. As far as the allergy sufferer is concerned, all he or she can really do is try to avoid the offending food, scrupulously carry around prescribed medication, devise an action plan for when things go wrong - and wait and hope for better treatments to be developed. Further research is the customer's best hope. The fact that our knowledge is incomplete poses obvious difficulties for support groups, which rely on information provided by the medical community. This information may have to be modified from time to time and it may even change altogether. Key messages conveyed by support groups one year may be overturned the next, so that advice offered in good faith may later prove to have been unwise or...

Action Against Allergy

Action Against Allergy is an independent charity founded in 1978 by Amelia Nathan Hill. She was chronically ill with migraine, stomach upsets, painful limbs and joints and other severe symptoms and her doctor, who could find no cause, thought she was being poisoned. After many years of searching, she undertook an elimination diet devised by British allergy pioneer Dr Richard Mackarness and found subsequently that her health improved dramatically. Action Against Allergy, whose address is PO Box 278, Twickenham, Middlesex TW1 4QQ, adopts a wide definition of allergy, being convinced that its effects range from moderate symptoms to a severely debilitating chronic condition. AAA believes these can be triggered by a wide range of causes, including food, food additives, pollutants and chemicals. AAA does not confine its help to those who become subscribers. The organisation offers information packs, advisory leaflets covering diet and allergy management, and quick reference sources of...

Allergy to food additives20

An additive is a substance added to foods for preservation, coloration and some other purposes. Additives are numerous and include benzoates, metabisulphites and azodyes. The prevalence of adverse reaction to additives is 0.03-0.5 . Adverse reactions to additives occur in 20-25 of patients with aspirin intolerance and in 10-20 with chronic recurrent urticaria. IgE-mediated hypersensitivity, resulting in acute allergic reaction, has been described for azodyes, ethylene oxide and penicillin, and delayed-type hypersensitivity for nickel salt. A list should be provided of foods containing the additive that the patient does not tolerate. Clear labelling of packaged food helps to avoid accidental exposure.

Techniques for identifying allergens and quantifying allergenicity

A number of techniques have been used to identify allergenic proteins, most being based on the principle of Using ELISA or Western blotting, quantitative or semi-quantitative data on the binding of serum IgE to specific proteins can be calculated for individual patients. Generalisations on allergenicity of specific proteins in a food are made by assessing the proportion of affected individuals that have elevated IgE to that protein. These methods cannot predict the degree of symptoms that may be produced on exposure to each individual protein or the outcome of introducing novel foods into a community.

Common food allergies

Table 10.10 compares clinical reactions to foods, and Table 10.11 compares skinprick specific IgE reactions to foods, between allergy clinic populations from different countries. As such they deal with a selected population and some studies involve small numbers. They show that cows' milk and egg are among the 2-3 commonest foods causing allergy in most countries. Peanut, fish, soy, wheat and shellfish are among the next most common groups of foods causing allergy, although significant variations occur between countries. Thus, for example, shellfish allergy appears to be more common in countries such as the Philippines, Thailand and Singapore where it is a part of the staple diet from early infancy, than in many other countries where it is consumed later and less commonly. In contrast, clinical peanut allergy which is a big problem in Western countries appears to be less common in most Asian countries, and also in Spain (Crespo et al. 1995). Thus in Japan it is very rare (Hill et al....

Unreliability of Self Reported Food Allergy

Reports of food allergy from individuals or parents of children are notoriously unreliable. Such reports have to be treated with scepticism. It is common for parents to believe that foods are responsible for a variety of childhood symptoms. Double-blind provocation tests in children with histories of reactions to food only confirm the story in one-third of all cases. In the case of purely behavioral symptoms, the proportion that could be reproduced under blind conditions was zero. The same is true of adults' beliefs about their own symptoms. If unnecessary dietary restrictions are to be avoided, one has to be sceptical, and it may be necessary in some cases to seek objective confirmation of food intolerance. The gross overreporting of food allergy has to be borne in mind when examining data on prevalence that are based on unconfirmed subjective reports.

Allergenic Aspects of Egg Proteins

Eggs are one of the most common causes of food allergies in infants and young children. Although the majority of egg allergies are caused by egg-white protein, proteins in both the egg white and the yolk are associated with allergies. The egg white contains 50 ovalbumin, which is the major allergen. Other egg-white allergenic proteins are ovomu-coid, ovotransferrin, and lysozyme. Most egg allergies in young children are outgrown by the age of 5 years following an elimination diet. Owing to the allergenicity of egg proteins, it is advised not to feed egg yolks to infants younger than 6 months of age and to wait until children are 12 months old to feed them egg whites. When feeding egg yolks to children between the ages of 6 months and 12 months, the eggs should be prepared in such a way that the egg white can be completely removed, as in hardboiled eggs.

Foods commonly associated with allergy Table

Yunginger et al.3 and Sampson et al.4 showed the most common cause of severe food-related allergic reactions in adults and older children to be peanuts, crustaceans, shellfish, tree nuts and fish. In selected American children with atopic dermatitis (eczema), Burks et al.5 showed that skin prick testing with eight foods identified 99 of subjects who reacted to a food in DBPCFC, even if the food causing the reaction in the challenge had not been one of the foods used for skin testing. Or, put another way, subjects who reacted to an unusual food nearly always had a positive skin prick test (SPT) to one of the eight foods used for screening with or without associated symptoms on exposure to that food. Such studies need to be repeated in different populations of subjects. There are clearly geographical variations regarding these foods because the lists involved in reactions in Britain6 are like American lists but European studies give slightly different figures regarding allergic...

Avoiding Foods to Prevent Allergy

Food allergy has been estimated to affect approximately 1 or 2 of infants and young children in Western Europe and is assumed to be increasing in line with other forms of atopic disease, although evidence to support this is limited. Some food allergies (e.g., peanut allergies) can persist into adulthood and in severe cases can be life threatening. Most confirmed food allergies are associated with a relatively limited range of foods, including cow milk, eggs, tree nuts, peanuts, soybeans, wheat, fish, and shellfish. The development of food allergy depends on several factors, including genetic factors and early exposure to allergenic proteins in the diet, food protein uptake and handling, and the development of tolerance. However, it remains uncertain whether sensitization occurs in utero and, if so, whether this occurrence is restricted to specific stages of gestation. There is little evidence to support any benefit of avoiding specific foods during pregnancy to reduce the risk of...

Human Health Risks Allergenicity

Many children in the U.S. and Europe have developed life-threatening allergies to peanuts and other foods. There is a possibility that introducing a gene into a plant may create a new allergen or cause an allergic reaction in susceptible individuals. A proposal to incorporate a gene from Brazil nuts into soybeans was abandoned because of the fear of causing unexpected allergic reactions. Testing of GM foods may be required to avoid the possibility of harm to consumers with food allergies.

Food Allergy

The ancient Roman poet and philosopher Lucretius was quoted as saying One man's food may be another man's poison. Although Lucretius was not referring to food allergies, his quote applies nicely to these illnesses. Most foodborne illnesses have the potential to affect everyone in the population. However, food allergies affect only a few individuals in the population. Food allergies involve an abnormal immunologic response to a particular food or food component, usually a naturally occurring protein component of the food. The same food or food component would be safe and nutritious for the vast majority of consumers. True food allergies can occur through two different immunologic mechanisms, the antibody-mediated mechanism and the cellular mechanism. The most common type of food allergies involve mediation by immunoglobulin E, or IgE.

Latex Allergy

At highest risk of developing IgE-mediated latex allergy are individuals with high exposure to latex and those who are atopic. Workers in industries that make rubber products (e.g., tire manufacturers and doll makers) and those who use rubber products (e.g., housekeepers, hairdressers, and health care workers) are at high risk of developing this allergy.90 While anyone can develop latex allergy, specific patient populations are at higher risk. Individuals likely to develop latex allergy include those with a history of multiple allergies (including dermal, respiratory, oral, or facial reactions to latex or rubber products) asthma (reactive airways disease), eczema, multiple food allergies (especially to bananas, avocados, and other tropical fruit), frequent surgical or dental procedures, multiple urogenital procedures (e.g., bladder, vaginal, and rectal), spina bifida and related conditions of spinal dysraphism, congenital urinary anomalies, or sensitivity to ethylene oxide (a...

History of Allergy

A history of asthma or severe allergy (e.g., anaphylaxis) to one or more allergens is associated with an increased risk of a contrast reaction. Patients with a history of asthma may have a fivefold greater risk of an adverse reaction than in the general population, and a history of allergy may double the risk. 1 A history of reaction during a previous contrast administration is associated with a three- to eightfold greater risk of a subsequent adverse reaction than in the general population. 1

Allergy

Food allergy is discussed elsewhere (see 00122 and 00123). It is a frequent diagnosis in childhood. Diarrhea, rashes, and wheezing are common symptoms caused by infection probably more commonly than by food allergy. Parental desire to explain a child's frequent illness may lead to food being wrongly blamed for recurrent symptoms. Vague associations between food and the development of symptoms can result in many foods being unnecessarily excluded and children reduced to diets of very limited variety. For example, whilst 14 of children may be described as allergic to some food, as few as 5 may have had this diagnosis confirmed by their medical practitioners.

Insect Sting Allergy

Treatment is symptomatic and supportive. Mild local reactions can be managed with application of ice and oral antihistamines. More generalized reactions or local reactions of the head and neck may benefit from a short steroid course. Severe reactions are managed as outlined under Treatment above. Patients with severe reactions should be advised to carry self-administered epinephrine and antihistamines. A referral to an allergy specialist is indicated. I3,,7., 3

Drug Allergy

Although adverse reactions to drugs are a common clinical problem, true immunologically mediated hypersensitivity reactions probably account for less than 10 percent of these problems. Since most drugs are small organic molecules, they are generally unable to stimulate the immune system alone. However, when a drug or metabolite becomes protein bound, either in serum or on cell surfaces, the drug-protein complex can become an allergen and stimulate immune system responses. Thus, the ability of a drug or its metabolites to sensitize the immune system depends on the ability to be bound to tissue proteins. Approximately 100 to 500 patients die yearly of anaphylactic drug reactions. Penicillin is the drug most commonly implicated in eliciting true allergic reactions and accounts for approximately 90 percent of all allergic drug reactions. Of those patients who had fatal anaphylactic drug reactions, over 95 percent reacted to penicillin. Only about 25 percent of patients who die of...

Drugs Allergy To

Comes, in individuals already sufficiently ill to warrant pharmacologic intervention. About 1-5 of hospitalized patients experience an allergic reaction to a medication. Approximately 10 of adults have experienced an allergic reaction to a drug. Identification of the offending agent, reversal of the immun-opathologic processes, and introduction of effective alternative therapy can be very difficult challenges. The human and financial costs of these reactions are considerable. In fact, the morbidity and mortality induced by allergic reactions to drugs unambiguously make this one of the most important categories of immunologically mediated disease. Inherent in drug therapy of humans is the administration of potential immunogens in standard doses and intervals in the context of somewhat similar clinical disorders. As relevant drug epitopes are defined in biochemical terms, primary and secondary immune responses can be studied in the context of current understanding of immunogenetics,...

Clinical Features

The evaluation of human bites should identify the time interval since the injury, mechanism (i.e., occlusion versus closed fist), location, estimated depth of penetration, tetanus immunization status, medications, allergies, and underlying medical conditions predisposing to poor wound healing. As mentioned, human bites in the hands have an increased predilection for infection, but clinical signs of infection may not be present even after 24 h postinjury. Documentation of the vascular, motor, and sensory examination is essential. Following appropriate anesthesia, careful wound exploration is necessary to examine underlying structures for injury and possible foreign bodies. Examination of a CFI wound must take into account the flexed position at the interphalangeal and metacarpophalangeal joints at the time of injury the injured segment of tendon will retract proximally in the unclenched, open hand and be missed if the physician evaluates the wound only in this position. The wound must...

Ring Tourniquet Syndrome

A tight ring encircling the proximal phalanx may become entrapped because of distal swelling. Such swelling may be the result of trauma, infections, skin disorders, allergic reactions, or the tight ring alone. As the digit expands, venous outflow is restricted by the tight ring, producing more swelling. This vicious cycle may lead to nerve damage, ischemia, and digital gangrene.

Frequency of individual symptoms

Vomiting and abdominal pain (not shown in the table) were rarely isolated features of a reaction. Abdominal pain correlated more strongly with severe symptoms than did vomiting. Abdominal pain also correlated more strongly with severe symptoms than did more minor symptoms such as rash or itch. Abdominal pain may be an under-appreciated symptom of at least moderately severe allergic reactions to peanut.

Biosynthetic Functions

Biogenic amines are removed from the pulmonary circulation in varying degrees. Serotonin (or 5-hydroxytryptamine) occurs in the lungs as a product of alveolar macrophages and pulmonary mast cells, in addition to arriving by the circulation. A carrier-mediated uptake process in the pulmonary endothelium almost completely removes serotonin from the blood. Norepinephrine occurs in the lungs from local activation of sympathetic nerve endings. Norepinephrine is removed from the blood by a carrier-mediated process into pulmonary endothelial cells, which contain enzymes to degrade the neurotransmitter. However, this pulmonary uptake mechanism is not effective at controlling systemic norepinephrine levels. Histamine is stored in large amounts in pulmonary mast cells in the airway walls and epithelium. Histamine can be released from these cells by allergic reactions and causes bronchial smooth muscle contraction and pulmonary vasoconstriction. Enzymes for degrading histamine occur in the lung,...

General References

Challacombe, eds., Food Allergy and Intolerance, Bailliere Tindall, London, United Kingdom, 1987. P. J. Lemke and S. L. Taylor, Allergic Reactions and Food Intolerance in F. N. Kotsonis, M. Mackey, and J. Hjelle, eds., Nutritional Toxicology, Raven Press, New York, pp. 117-137. D. D. Metcalfe, H. A. Sampson, and R. A. Simon, eds., Food Allergy-Adverse Reactions to Foods and Food Additives, Blackwell Scientific Publications, Boston, Mass., 1991. J. E. Perkin, ed. Food Allergies and Adverse Reactions, Aspen Publishers, Gaithersburg, Md., 1990. W. Strober, Gluten-Sensitive Enteropathy A Nonallergic Immune Hypersensitivity of the Gastrointestinal Tract, J. Allergy Clin. Immunol. 78, 202-211 (1986). R. S. Zeiger and S. Heller, The Development and Prediction of Atopy in High-Risk Children Follow-up at Age Seven Years in a Prospective Randomized Study of Combined Maternal and Infant Food Allergen Avoidance, J. Allergy Clin. Immunol. 95, 1179-1190 (1995).

Food allergens additives and chemicals

By carefully reviewing the specialized publications on food allergy, it appears that any food can be potentially allergenic. However, this potential is largely related to ethnic and cultural feeding habits it is nor surprising that allergy to cow's milk or fish is frequent in populations consuming large amounts of these foods. However, with the standardization of feeding habits in the world, exotic or unusual foods may develop their allergenic potential. Kiwi fruit were almost unknown in Europe 15 years ago, but now they have become a frequent allergen. Therefore, common sense dictates that the eating habits of a patient who is suspected of being allergic to a certain food(s) should be carefully noted. Indeed, the existence of another focal allergy is of major importance. For instance, the knowledge of cross-reactivity between inhaled and ingested allergens demonstrates clearly the frequency of this problem. As an example, the cross-antigenicity between birch pollen and several fruits...

Scene and Circumstances Accidental Choking Deaths The phases of acute fatal airway obstruction are

Witnesses of a sudden death may describe signs of acute upper airway (glottic) obstruction (stridor, respiratory distress, coughing, choking) and the inability of the victim to speak (334-337). A rapid, deep inhalation frequently follows, causing a foreign object to pass further down the airway (333,338). Laryngospasm occurs (338). At this point, vagal stimulation, leading to arrhythmia and apnea, is a possible mechanism of death (339). An allergic reaction, manifest as laryngeal mucosal edema, happens under some circumstances (e.g., aspiration of pepper 340 ). In some cases of foreign body obstruction in the esophagus and lower tracheobronchial tree, there is an asymptomatic period prior to the onset of respiratory symptoms (coughing, wheezing, dyspnea 334,336,341,342 ). When hot liquid is aspirated, the onset of symptoms (difficulty speaking, dyspnea) develops following a latent period, up to 8 h (343). Incomplete obstruction eventually becomes complete when respiratory tract...

Websites and addresses

American Academy of Allergy, Asthma and Immunology www.aaaai.org British Allergy Foundation Deepdene House, 30 Bellegrove Road, Welling, Kent DA16 3PY Tel. 020 8303 8525 Fax. 020 8303 8792 www.allergyfoundation.com Food Allergy Network www.foodallergy.org Ortolani C, Bruinzeel-koomen C, Bengtsson C et al. 'Controversial aspects of adverse reactions to food', Allergy, 1999 54 27-45. Sampson H A, 'Food allergy. Part 2 Diagnosis and management', J Allergy Clin Immunol, 1999 103 981-9.

Immunological and Molecular Mechanisms

And potent response against foreign substances, develop tolerance to ingested food antigens. The means by which tolerance develops is poorly understood, but it is believed that failure to develop tolerance leads to food allergy. The relatively low salivary secretory IgA concentrations, together with the large amount of ingested protein, contributes to the large amount of food antigens confronting the immature GALT. In genetically predisposed infants, these food antigens may stimulate the excessive production of IgE antibodies or other abnormal immune responses.

Inability to Predict Outcome

The period of elimination was too short. For example, where a child has an enteropathy (damage to the small intestine) due to food allergy, it may take a week or more for improvement in symptoms to occur. 4. The subject is allergic to other items, which have not been avoided. For example, a child with an allergy to cows' milk protein who fails to improve when given a soy-based milk to which they also have an allergy.

Skin Application of Food Prior to Food Challenges

There is one situation where direct application of food to the skin may be of practical value, and that is prior to a food challenge in a child in whom one fears an anaphylactic reaction. An example might be a 6-month-old infant with a history of a severe allergic reaction to egg. If the parents wish to see if the child has outgrown the allergy without directly administering egg and risking a violent reaction, a simple approach is to rub some raw egg white into the skin and observe the skin for a few minutes. If the skin application of egg in this way causes an urticarial reaction, then a gradual diminution and disappearance of this response during the succeeding months and years can probably be taken to indicate the development of tolerance, and a continuing brisk response to skin contact would constitute a deterrent to an oral challenge. However, this is only an approximate guide, and there are a number of possible reasons why such testing may give false-positive (e.g., using a raw...

Cows Milk Protein Avoidance

Butter, margarine, cream, cheese, ice cream, and yogurt all need to be avoided. Fats that can be used instead include margarines made from pure vegetable fat (e.g., Tomor) and lard. Caution is required with baby foods, as a large number of manufactured products, e.g., rusks, contain milk protein. A common trap is so-called 'vegetarian' cheese, often wrongly believed to be safe for subjects with cows' milk allergy. In fact, it differs from ordinary cheese only in the use of nonanimal rennet and is unsuitable for people with cows' milk allergy. Meat, game, and poultry are all allowed, but sausages and pies should be avoided unless it is known that they are milk free. Intolerance to cows' milk protein is not a reason to avoid beef. Eggs are allowed, but not custard or scrambled egg which may contain milk. Fish is permitted, unless it is cooked in batter (which unless otherwise stated should be assumed to contain milk) or milk. Lemon curd, chocolate spread, chocolate (unless stated to be...

Patient Evaluation

The first step is assessment of the patient for sedation in the emergency department. The history should identify any abnormalities of the major organ systems and airway previous adverse experience with sedation, analgesia, or anesthesia any neurologic disorder or impairment medications and allergies and time and nature of the patient's last oral intake. Focused physical examination should include baseline vital signs and oxygen saturation, evaluation of cardiorespiratory status and the oropharynx and airway.

Chemistry metabolism and distribution

Histamine is widely distributed throughout the various tissues of the human body the name derives from the Greek word for tissue, histos. Every mammalian tissue that contains the amine is capable of synthesizing it from histidine by virtue of L-histidine decarboxylase. In most tissues the bulk of the amine is stored in the secretory granules of mast cells. In the blood, histamine is contained in the circulating counterpart of the mast cell, the basophil leukocyte. Histamine and other inflammatory mediators are released by the immunological activation of these cells in the course of immediate hypersensitivity reactions and thereby contribute to the symptoms of allergy and anaphylaxis. Histaminergic neurons of the central nervous system constitute an important non-mast cell source of the amine in humans (see below).

Pharmacologic effects

Localized allergic reactions to food or aeroallergens are generally confined to particular target organs, such as the airways, eye, gut and skin. However, more generalized, systemic responses may occur, typically in anaphylactic or anaphylactoid reactions to various drugs, agents used in surgical or preoper- The role of histamine in allergy and atopy is well established. As discussed, the amine is released from tissue mast cells and circulating basophil leukocytes by immunoglobulin E (IgE)-dependent mechanisms. This release may be modulated by histamine H> autoreceptors which appear to be present on the sur facc of the human basophil but not the lung mast cell. See also Atopic allergy Basophils Mast cells Hypersensitivity reactions IgE.

Sources of further information and advice

Review articles on food allergy, prevention and diagnosis, in addition to those mentioned in references, include the following Van Putten, M. C. Frewer, L. J. Gilissen, L. J. W. J. Gremmen, B. Peijnenburg, A. A. C. M. and Wichers, H. J. (2006). Novel foods and food allergies a review. Trends in Food Science and Technology, 17, 289-299. Zuercher, A. W. Fritsch , R. Corth sy, B. and Mercenier, A. (2006). Food products and allergy development, prevention and treatment. Current Opinion in Biotechnology, 17, 198-203. Sicherer, S. H., Sampson, H. A. (2006) Food Allergy. Journal of Allergy and Clinical Immunology, S470-S475. Ortolani, C. Pastorello, E. A. (2006). Food allergies and food intolerances. Best Practice and Research Clinical Gastroenterology, 20, 467-483.

TABLE 641 Physiologic Consequences of Airflow Obstruction

Asthma is associated with no family history or personal history of allergy and normal serum levels of IgE. Many stimuli have been noted to provoke an increase in airway responsiveness. Viral respiratory infections are the most common of the stimuli that invoke acute asthma exacerbation.11 Increased airway responsiveness secondary to infection may last anywhere from 2 to 8 weeks.11 Exercise is another common precipitant of acute asthma. Unlike other precipitants of acute exacerbation, long-term sequelae and airway reactivity are not noted as a result of exercise. Environmental conditions, such as atmospheric pollutants and antigens noted in heavy industrial or densely populated urban areas, are associated with higher incidence and severity of asthma. In addition, indoor antigens such as mold, house dust mites, cockroaches, and animal dander, are also associated with acute asthma. Occupational exposures, such as metal salt, wood and vegetable dust, pharmaceutical, industrial chemical...

Antimicrobial Prophylaxis

For patients with a history of penicillin allergy, clindamycin remains appropriate. Alternatives include macrolides, such as clari-thromycin or azithromycin, which have demonstrated efficacy in experimental models and have convenient dosing regimens, although they are more expensive. Cephalosporins also have demonstrated efficacy, but should not be used in patients with a history of type 1 (immedi-ate-type anaphylaxis) hypersensitivity reaction to P-lactams. For patients unable to take medication orally, intravenous regimens are recommended, and administration of the full dose should be completed within 30 minutes of the procedure.

TH1 versus TH2 the importance of an appropriate response

Type I cytokines help to control viral infections by activating NK cells and CTLs. The type II cytokines, especially IL-4 and IL-5, are relevant to immune responses to extracellular parasites and the development of allergies by virtue of their ability to induce IgE production in B cells and enhance the growth of mast cells. The disease leishmaniasis illustrates the importance of activating the appropriate T helper subset. Protection from the disease is dependent upon the activation of the Th, pathway which leads to IFNy production, macrophage activation and parasite killing, and inhibits IL-4 production. In experimental mice, deviation towards a Th2 response can result in death. Multiple factors can influence T cell function and cytokine polarization, including the genetic background of the host, the type of APC, the nature of the costimulatory and accessory molecules, the affinity of the antigen for the MHC and the antigen-MHC complex for the TCR.

Reasons Against Prophylaxis

Since IE is potentially fatal, prophylaxis seems reasonable. The benefit of giving antibiotic prophylaxis to otherwise healthy people, however, should outweigh its risks. The major complications associated with administration of prophylaxis include allergic reactions, toxic side effects of antimicrobials, adverse interactions with other drugs, and development of resistant organisms.

Treatment of mild or localised reactions

A mild form of urticarial rash and itching may be the only manifestation if the sensitivity to food is low or only a small amount has been ingested. Oral symptoms, of swelling and numbness of the lips and localised itching, are common symptoms of allergy to fresh or raw fruits in some patients who are highly sensitive to pollen (oral allergy syndrome). Treatment with oral antihistamine may be sufficient for these episodes. Patients should keep a supply of non-sedating antihistamine such as cetirizine (10 mg) or loratidine (10 mg) tablets. For children, antihistamine syrup (cetirizine or chlorpheniramine) should be prescribed. If the episode does not respond to oral antihistamine or if there are signs of progression, medical help should be sought.

Camacho F. Gonzalez Tello P. Paez Duenas M.p. Guadiz E.m. Guadix A. 2001 Correlation Of Base Consumption With The

For the investigation of food allergy', Toxicology, 91, 281-288. aubry af, caude m, rosset r (1992), 'Separation and idantification of dipeptides in a hydrolyzed brain extract', Chromatography, 33, 533-538. baird aw, coombs rra, mclaughlan p, cuthbert qw (1984), 'Immediate hypersensitivity reactions to cow milk proteins in isolated epithelium from ileum of milk-drinking guinea-pigs comparison with colonic epithelia', International Archives of Allergy and Applied Immunology, 75, 255-263. balny c, mason p (1993), 'Effects of high pressure on proteins', Food Review International, 9, 611-628. BENLOUNES N, DUPONT C, CANDHAL, BLATON MA, DARMON N, DESJEUX JF, HEYMAN M (1996), 'The threshhold for immune cell reactivity to milk antigens decreases in cow's milk with intestinal symptoms', Journal of Allergy and Clinical Immunology, 98, 781-789. BERETTA B, CONTI A, FIOCCHI A, GAIASCHI A, GALLI CL, GIUFFRIDA MG, BALLABIO C, RESTANI P (2001), 'Antigenic determinants of bovine serum albumin',...

Flea control and management

A number of factors will influence the type of flea-control programme that should be implemented to deal with cats that have either flea infestation or flea allergy. Such factors include For cats with flea allergy it is preferable to use a spray or spot-on product formulation because it is important to attempt to prevent fleas reaching the skin to bite and such products tend to have a rapid onset, and long duration, of activity. Such products include fipronil, imidocloprid and selamectin they can usually be administered on a monthly basis as part of a flea-control programme. Other spray products may contain organophosphates and permethrins and last for 7-14 days. Spray products tend to be difficult to apply to cats that resent restraint. It is important to consider the weight of the cat and coat length when applying sprays, to ensure that appropriate quantities and coverage of the coat are achieved. The spot-on products are very convenient to apply to cats and are rarely associated...

Chapter References

Goldberg MJ, Park GD, Berlinger WG Treatment of theophylline intoxication. J Allergy Clin Immunol 78 811, 1986. 13. Melamed J, Beaucher WN Minor symptoms are not predictive of elevated theophylline levels in adults on chronic therapy. Ann Allergy Asthma Immunol 75 516, 1995.

Production of eosinophils in vivo

Transgenic mice overproducing IL-5 showed highlevel eosinophil production which was proportional to the transgene copy number. These animals have detectable levels of IL-5 in the serum, and show a profound and lifelong eosinophilia, with large numbers of eosinophils in the blood, spleen, bone marrow, lung and gut wall. Interestingly, despite the massive long-lasting eosinophilia, the mice remained apparently normal. This illustrates that increased numbers of eosinophils are not themselves harmful. The tissue damage seen in allergic reactions and other diseases must be due to other factors.

Likely future developments

Discussions are currently underway regarding the future development of the databank. The difficulties in identifying allergenic ingredients from product labels have not been resolved and there is still likely to be an important future role for the databank, even if the labelling of allergens becomes mandatory in the EC (see Section 6.7.2).

Heterologous Enzyme Production

Regular enzyme application in the dough system is carried out by exogenous addition of commercial preparations. Although substantial amounts of these compounds are obtained from recombinant organisms, mainly fungi and bacteria, all of them contain a cocktail of minor enzymatic activities that may negatively affect bread quality. Moreover, these products may act as allergens, producing a high prevalence of occupational hypersensitivity, in terms of dermal and bronchial (asthma) allergies (164-166). Alternatively, recombinant baker's yeast strains producing a technological enzyme can be employed to obtain the same benefits, avoiding airborne allergen pollution at the workplace (167).

Carbonic Anhydrase Inhibitors

The prototype for this subclass of diuretic is acetazolamide, which is a nonbacteriostatic sulfonamide whose adverse reactions include severe allergic reaction and Stevens-Johnson syndrome. The primary action of this class of diuretic is to inhibit carbonic anhydrase in the kidney to prevent the reversible reaction of carbon dioxide and water to form carbonic acid. This results in loss of bicarbonate ions in the urine, along with sodium, potassium, and water. Overdose with this class of medication can lead to volume depletion and electrolyte disturbances, as well as non-anion-gap metabolic acidosis. Treatment is directed at reversing volume depletion, monitoring electrolytes, and restoring normal pH balance.

Immune modulation by IL12

Ate reduction of early IgGl production, it led to weakly enhanced late IgGl and strongly enhanced IgG2a, IgG2b and IgG3 responses. An established IgE response could not be permanently suppressed. Under certain conditions, the induction of an IgE response was even enhanced. This adjuvant effect of IL-12 has been successfully employed to immunize mice with defined bacterial protein antigens. While poor in vivo protection was achieved with Al(OH)3 as adjuvant, IL-12 supported the development of protective immunity comparable to whole bacterial vaccines. The involvement of endogenously produced IL-12 was also demonstrated for the induction of contact sensitivity that represents a classical THl-type response. When administered together with a contact allergen, IL-12 also functioned as an adjuvant.

Urticaria And Angioedema

Urticaria, or hives, is a cutaneous IgE-mediated reaction marked by the development of pruritic, erythemic wheals of varying size that generally disappear quickly. Erythema multiforme is a more pronounced urticarial variant, characterized by typical target lesions. Angioedema is believed to be an IgE-mediated reaction characterized by edema formation in the dermis, most generally involving the face and neck. These manifestations may accompany many allergic reactions. As with all allergic manifestations, a detailed history of exposures, ingestions, medications, and infections and a family history should be obtained. If an etiologic agent can be identified, future reactions may be avoided. Treatment of these reactions is generally supportive and symptomatic, with attempts to identify and remove the offending agent. Epinephrine, antihistamines, and steroids are most often tried. Oral antihistamines and steroids for several days may be beneficial. The addition of an H 2 receptor blocker,...

TABLE 482 Contraindications to Fibrinolytic Therapy in Acute Myocardial Infarction

Antibodies may develop after treatment, so retreatment should be avoided. Streptokinase allergy can be seen in approximately 5 percent of patients treated for the first time, especially those with a recent Streptococcus infection. Self-limited allergic reactions usually respond to antihistamines. Fewer than 0.2 percent of patients experience a serious anaphylactic reaction. During intravenous administration, approximately 15 percent of patients will experience hypotension, which usually responds to decreasing the rate of infusion and volume expansion. The 1998 recommended dose of streptokinase is 1.5 million units over 60 min, which produces a fibrinolytic state for up to 24 h. Streptokinase is less costly than other fibrinolytic agents.

Future labelling trends

Importance, in order to allow them to make informed decisions, and is becoming increasingly recognised as essential where a public health risk is concerned. It has not, therefore, been surprising that the labelling of potentially allergenic compounds in foods has become a key issue, particularly as product liability laws will also need to be considered in the event of a consumer having a reaction from an unlabelled product. Although a number of countries have their own provisions in place or at the proposal stage, there is considerable interest in the Codex and EC proposals in this respect. Owing to the reference role of Codex standards in World Trade Organisation agreements and possible trade disputes, many countries will undoubtedly focus on Codex provisions once agreed. Adoption of an amending Directive at EC level will have direct implications for each of the EU Member States and for those wishing to become part of the expanded Union in the future. Two issues are apparent and of...

Glycosaminoglycans Chondroitin Sulphate

Glycosaminoglycans (GAGs) (mucopolysaccharides) are polymers of acidic disaccharides containing derivatives of the amino sugars glucosamine or galactosamine. Sulphated polysaccharides abound in vertebrate tissues, and some invertebrate species are a rich source of sulphated GAGs with novel structures. The anticoagulant and antithrombotic characteristics are among the most widely studied properties of the sulphated polysaccharides, for example the anticoagulant GAG heparin is an important therapeutic agent in the prevention and treatment of thrombosis.A replacement agent for heparin is sought as there are problems with both allergy to heparin and heparin resistance. Recently isolated sulphated polysaccharides from the body wall of sea cucumbers, fucosylated chondroitin sulphates (FucCS), have structures analogous to heparin and have been investigated for possible biological activity in mammalian systems. Tapon-Bretaudiere et al. (2002) found that FucCS from a sea cucumber promoted the...

TABLE 1893 Management of Compartment Syndrome

Although recommended by some authors, no objective evidence supports the use of prophylactic antibiotics. 6 The use of steroids is also controversial. Several studies suggest lack of efficacy or even deleterious effects. Without evidence of efficacy, steroids should be reserved for the treatment of allergic reactions or the treatment of serum sickness.

Animal Toxins and Plant Toxicants

Overall, healthy individuals can tolerate naturally occurring toxicants. However, there are several conditions under which natural toxicants can create problems. Inborn errors of metabolism or certain drug interactions can make individuals prone to problems caused by natural toxicants. Whereas nutrients can be beneficial to most, they can be deleterious to some, e.g., consumption of lactose by lactose-intolerant people. Other examples include individuals with celiac sprue, sucrase deficiency, fructose intolerance, galactosemia, and phenylketonuria. Individuals taking drugs that inhibit monoamine oxidase enzymes can be affected when eating cheeses or drinking wines, which are high in tyramine. Individuals with sensitivities due to allergies can be affected by foods. Hypersensitivity to a particular substance produces anaphylactic shock. Examples of foods that cause allergies include milk, wheat, nuts, citrus, strawberries, fish (shellfish), and egg. Some individuals have bizarre food...

General Nutritional Management of Malabsorption

Review include duration of symptoms, underlying etiology of malabsorption, ability to meet nutritional needs by mouth, the presence of food allergies, and concurrent medical and surgical problems. The patient's nutritional status (weight, height, body mass index, and their respective percentiles) should

Safety And Quality Control Of Microbial Protein Products

Although experience shows that the standard levels fit well below these limits. In products of fungal origin, chemical analysis of absence of mycotoxins is considered essential (Scrimshaw 1985 Stringer 1985). (3) Pathogenicity. The potential pathogenicity of a microorganism used for feeding, has been evaluated by the injection of the viable organism into the body cavity or body fluids of a mammalian species. In this way the nonpathogenicity of a large number of microorganisms (S. cerevisiae, C. utilis C. maltosa, C. lipolytica, and Torulopsis) has been evaluated (Stringer 1985). (4) Integrity of the original strain. The maintenance of the integrity of the original strain and absence of undesirable contaminants has to be proved by specific microbiological and biochemical tests (Anonymous 1983c). (5) Continuous monitoring and control of process variables. To ensure quality and uniformity of the product the process variables (temperature, pH, aeration, cell concentration) have to be...

Factors influencing reactions to drugs

Clearly the structures, metabolism and chemical properties of specific drugs and their metabolites have important influences on human immune responses and the expression of clinical allergic reactions. The dose, route, duration and frequency of therapy also can influence the expression of allergic reactions to drugs. In addition, active disease processes, such as infections, and a variety of individual patient factors influence responses. Several human factors also can influence the expression of drug allergy. While the full importance of HLA class I and class 11 genes in drug allergy is not clear, both class I and II associations have been detected for some allergic reactions to some drugs. Genetically determined differences in drug metabolism are known to influence susceptibility to reactions to some drugs, including isoniazid and hydrala zine. A familial propensity to allergic reactions to structurally diverse antimicrobial drugs has been reported. Some individuals have a...

Nutrition Management Guidelines

Grain may provide twice as much energy as a coffee can of another. Avoid dusty or moldy feed. Horses are very susceptible to respiratory disease because of allergies to dust from feed. Horses are more susceptible to mold toxins in feed than are ruminants. 10. There is no one best feed or diet. A wide variety of ingredients can be used in horse rations if the diets are properly formulated and processed.

Skin Disorders Affecting The Nipple And Breast

Atopic dermatitis, which may affect one or both nipples, is manifested by areas of fissuring, weeping skin, or lichenification. This condition occurs in both pregnant and nonpregnant women, most commonly between the ages of 15 and 30. This dermatitis is more common in atopic individuals. Underlying causes of these skin changes include scabies, contact allergy, local medication reaction, and irritation secondary to friction. 5

Class I Antidysrhythmic Agents

Common Emergency Department (ED) Indications Procainamide is a second-line agent generally used to treat and prevent recurrence of ventricular dysrhythmias, specifically stable ventricular tachycardia (VT) and premature ventricular contractions (PVCs) that are unresponsive to lidocaine. It is infrequently used in ventricular fibrillation (VF) or pulseless VT because it takes so long to achieve therapeutic concentrations. Procainamide may also be used for slowing or converting supraventricular tachycardias (SVT) including atrial flutter and fibrillation especially in Wolff-Parkinson-White (WPW) syndrome , paroxysmal supraventricular tachycardia (PSVT), paroxysmal atrial tachycardia (PAT), and paroxysmal atrioventricular (AV) junctional rhythm. Contraindications include complete AV heart block, second- or third-degree heart block (without an electrical pacemaker present), long QT intervals, and torsades de pointes. The drug should be used cautiously in patients with systemic lupus...

Molecular characteristics of common allergens

The majority of allergens described are protein in nature with or without carbohydrate moieties (glycosylated), with a molecular weight ranging between 10-100 kDa. Most proteins in foods can be immunogenic and provoke production of specific antibody, mainly IgG, in individuals with or without an atopic tendency. Only a limited range of proteins is commonly associated with the production of IgE in the atopic individual, and is considered allergenic. Protein molecules that initiate immune responses are commonly over 7000 daltons in size (Roitt et al. 1998). No common molecular motif for allergens has been described, but they do have some properties in common. Allergens, particularly those that lead to persistent allergies, are thought to be resistant to digestion (Astwood et al. 1996, Becker 1997), the rationale being that this results in persistence in the body and stimulation of the immune system. There are certain fruit allergens, which may be unstable, even being degraded by enzymes...

Perspective and implications

Allergic conditions and indeed may be valid for many other diseases which are presently categorized as being autoimmune in nature. Again, understanding of the mechanism of immune memory may lead to novel therapies for both prophylaxis and therapy of these and other related diseases.

Modulation by Probiotics

Specific probiotic bacteria can modulate both the intestinal microflora and local and systemic immune responses. Activation of immunological cells and tissues requires close contact of the probiotic with the immune cells and tissue on the intestinal surface. Interestingly, both lactobacilli and bifidobacteria, which colonize mainly the small and large intestine respectively, when given as probiotic supplements were able to modify immunological reactions related to allergic inflammation, whereas lactobacilli were ineffective in protection against cows' milk allergy. In this respect, preferential binding of probiotics on the specific antigen-processing cells (macrophages, dendritic, and epithelial cells) may be even more important than the location of adhesion. It is also known that the cytokine stimulation profiles of

Detection of specific proteins the immunoassay

The most commonly used technique for quantification of allergenic or antigenic substances is the enzyme-linked immunosorbent assay (ELISA). ELISA has the advantage over radioimmunoassay (RIA) of being more cost-effective and, with modern techniques, not compromising sensitivity. The specificity of all immunoassays is in part dependent on the efficiency of the capture and detector antibodies. Once optimised and standardised the ELISA is relatively economical, and large numbers of samples can be analysed on each test run. The assay is carried out in standard plastic 96 well plates designed for use in ELISA. The wide use of such plates has led to a variety of plate washing and reading systems being available. The sensitivity of the antibodies in forming a complex with the protein is paramount for the sensitivity and specificity of the assay. The sensitivity of the basic assay may be further increased by using indirect labelling or amplification techniques. In non-competitive assays all...

Heat treatment and cooking

As a general rule heat decreases the allergenicity of proteins, and heat in the presence of moisture even more so, but this biological activity is rarely removed. Allergenicity of whole wheat flour or purified gluten is only reduced and not eliminated by heating up to 120oC for up to one hour (Varjonen et al. 1996, Sutton et al. 1982). Heating rice glutelin and globulin fractions also reduces IgE binding ability by 40-70 (Shibasaki et al. 1979), but the food remains allergenic. Peanut and nut allergens are resistant to heating and even roasting.

TABLE 21110 Contraindications to Thrombolytic Therapy

Bleeding is the major complication of thrombolytic therapy. Less common complications include fever, embolization of thrombi, and allergic reactions. Bleeding complications are primarily due to the dissolution of hemostatic plugs at sites of recent vascular injury. Superficial bleeding is usually not a major problem and can be controlled with local measures. Thrombolytic agents are discontinued at the first indication of major bleeding. Although the half-life of the thrombolytics is short, the systemic fibrinolytic state remains for 12 to 36 h after the infusion is stopped because it takes that long for fibrinogen to replenish itself. Cryoprecipitate can be given to replete fibrinogen and reverse the lytic state. EACA can also be given to inhibit the fibrinolytic state.

Identification of allergens

The main challenge to the food industry is to provide accurate and up-to-date information at all times so that sufferers of allergies can select foods with confidence. Nut oils are an area worthy of comment. Research suggests that refined, bleached, deodorised nut oils do not initiate allergic reactions,2 even in those who are anaphylactic to nuts. Unrefined, cold pressed or virgin nut oils are chosen specifically for their distinctive flavour. These oils are not refined and contain small amounts of protein from the original nut. The same research study showed that unrefined oils were able to cause reactions in individuals who have suffered previous anaphylaxis, but that generally the reactions were not as severe as those experienced when nuts were eaten. The small amount of protein that is present in unrefined oils is removed through the process of refining, bleaching and deodorising, rendering the oils suitable for allergy sufferers.

Types of Normative Theory

IfJones tells a lie to Smith that causes Smith to miss his train, then Jones is the agent, his telling a lie is the action, and Smith's missing the train is one of the consequences of the action. Difficulties arise, of course, in many cases in determining whether someone is an agent in a particular case (e.g., if Jones is insane when he shoots the president, is he really the agent of any action ) or the nature of the particular action performed (e.g., if Jones is cutting down a tree, believing reasonably that he is the only one in the forest, but Smith wanders by and the tree falls on him, causing his death, does a killing take place or merely a death ) or what the consequences of a particular action may be (e.g., if Jones tells Smith Take the stuff, but Smith understands him to say Take the snuff, with the consequence that he takes the snuff and due to a hitherto undiscovered allergy becomes ill, is his illness a consequence of Jones's action in saying Take the stuff ). These are...

Person Responsible Mixer operator

Background to the HACCP studies and the actions that must be taken. Briefing about allergies should be included in all induction sessions and regular updates will ensure that staff continue to be well informed. It is particularly important that information is given to all those who work in an area that handles nuts and peanuts, and all staff understand the importance of the quality controls.

Control of allergens throughout the supply chain 841 Crosscontamination

All aspects of the supply chain must be evaluated for presence or risk of contamination with key allergens. This includes purchasing of raw or semifinished materials, transport of these materials, storage within the production unit, production, packing and distribution. At each stage full HACCP evaluations of all equipment used, processes and risks need to be undertaken and documented to provide information on the suitability of the product for sufferers of different allergies. A full evaluation of a production line may involve many HACCP studies.

Background Definition

Insect bites or stings such as mosquito bites or Hymenoptera stings in general induce immediate and delayed cutaneous reactions. These vary from the common immediate wheal-and-flare reaction and delayed papules to the rare bullous eruptions and Arthus-type reactions. Insect stings of the order Hymenoptera (bees or vespids such as wasps (yellow jackets) and hornets) can also cause allergic reactions. Allergic reactions range from large local reactions through severe systemic reactions to an anaphylactic shock syndrome.

Aetiologyrisk factors

Immediate cutaneous reactions to insect bites are mediated by antisaliva IgE induced by the injection of the insect saliva.12 Reactions to Hymenoptera stings are caused by the venom of the stinging insect and can be either toxic (local reaction) or allergic (large local reaction, mild or severe systemic reaction). Patients who have been diagnosed with hypersensitivity to Hymenoptera venoms (positive skin-prick test and or presence of specific IgE) as well as patients with a previous history of systemic reactions to Hymenoptera stings are at higher risk for systemic allergic reactions than non-sensitised subjects.1,13-25