Allergy Clinics Ebook

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

More recently, the discovery of IgE imrnuno globulins by Ishizaka has considerably increased our understanding of immediate type I hypersensitivity. Having a more accurate means of measuring IgF-mediated reactions, it soon became evident that only a modest part of all the intolerances due to food could be verified by these new in vivo and in vitro procedures. Consequently, the concept of false food allergy (pseudoallergy) gained in importance and now, besides IgE-mediated reactions, a large variety of mechanisms has been proposed and sometimes verified by appropriate techniques.

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


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

Latex Allergy

Latex allergy is a concern in children and adults with meningomyelocele. It occurs in 24 to 67 percent of children with meningomyelocele. Increasingly severe allergic-type reactions are being reported related to latex and latex-containing products. Reactions vary from mild local reactions to anaphylaxis. Children may present with local or generalized swelling, hives or edema, itching, or a rash. Runny nose or eyes, coughing, sneezing, wheezing, stridor, and difficulty swallowing or breathing also may be presenting complaints. 1314 and 15 A history of latex allergy or sensitivity should be obtained in all children with meningomyelocele prior to any examination or procedure in which latex gloves or other latex-containing supplies may be used. Many routine medical supplies contain latex, including frequently used with meningomyelocele and latex allergy. If a severe allergic reaction is observed, the child should be discharged with an Epi-Pen, and formal testing for latex sensitivity...

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,...

Ring Tourniquet Syndrome

Syndrome Tourniquet

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.

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,...

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...

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...

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',...

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.

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...

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...

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...

Photoimmunology in humans

Although most of our information about photoimmunology comes from studies of laboratory animals, evidence of immunological effects of sunlight and UV exposure on humans is beginning to accumulate. Exposing human skin to sunlight or artificial sources of UV radiation causes the same types of alterations to human Langerhans cells as previously described in mice. Furthermore, human keratinocytes secrete a variety of immune modulatory factors following UV exposure, including IL-1, IL-6, Il.-lO, TNFa and PGE2. Sensitization of humans with contact allergens through the UV-irradiated skin also suppresses the contact hypersensitivity reaction. Interestingly, although the UV-induced suppression of contact hypersensitivity was evident in approximately 40-50 of irradiated normal human volunteers, almost 100 of skin cancer patients were susceptible to the suppressive effects of UV radiation. These findings not only suggest that there is a genetic component that influences the sensitivity of...

Confirmation of presence of allergens

Once all the above steps have taken place, food manufacturers are able to make a judgement based on all the evidence obtained as to whether a product contains or is free from a particular allergen. Information should be provided to allergy sufferers to enable them to select suitable foods for their diet. The provision of information to consumers on packaged food and food sold loose is discussed later in the chapter. In addition, a number of tests are available that can be used to analyse products for the presence of a given allergen. Generally a radio-immunoassay technique is used which checks samples of a product for specific proteins that have been previously identified as allergens. These tests can be useful, but in some instances results do need to be interpreted with care. Any analysis is only as accurate as the samples that are taken. The sampling of liquid or fluid foods gives a relatively reliable sample, as the food can be further blended to give an even distribution of all...

Food safety legislation

A failure to comply with these requirements because of the unnotified, inadvertent presence of an allergen in a product through manufacture or cross-contamination, could give rise to a criminal offence being committed, even though no intention existed. There is, however, a due diligence defence available to manufacturers in the event of proceedings under both the FSA and the GPSR which would require the manufacturer to prove that he had taken all reasonable precautions and exercised all due diligence to prevent inclusion of an allergenic material. Manufacturers can reduce the risk of prosecution and contribute substantially to the establishment of a due diligence defence by implementing Good Manufacturing Practice and documenting all procedures taken as evidence of GMP processes, training and results, as detailed earlier.

Protecting the Public Health

The FDA is responsible for not only drugs and biologics, but their regulatory authority also extends to food, medical devices, veterinary drugs, cosmetics, nutrition products, and radiation devices. Thus, they are responsible for protecting the health of the nation's citizens across a broad spectrum, including such areas as labeling of the nutritional content on food, approving only drugs found to be safe and effective for human or veterinary use, the allergenic potential of cosmetics, and the certification of mammography equipment. FDA further interprets new laws from Congress and promulgates regulations and guidelines for the industry to follow.

Current And Future Status

Recombinant DNA technology has been used to produce and improve pharmacologically useful peptides in microbial, plant, and animal cells. Production of heterogenous proteins in plants or milk by the transgenic technique is an especially promising method for the production of food protein. The amino acid composition and physical properties of food proteins can be improved by the site-directed mutagenesis technique. Furthermore, it will be possible to introduce biologically active peptide sequences into food proteins and to remove allergenic sequences from them.

Additional communication initiatives

The ingredients list on the label of a product is the most accurate way of assessing the suitability of a product for a sufferer of allergies. However, reading labels is a laborious and time-consuming process and makes shopping a lengthy ordeal. Most companies and retailers now produce lists of products free from key allergens which make food selection much quicker and easier. The lists are available from the companies directly and are often on the Internet. Once again peanut and nut allergies are often handled as a special case, as they are the most common food causes of anaphylaxis. 'Free-from' lists are updated every six months to reflect any changes that may have occurred. Users of lists are also advised to check ingredients' lists, particularly where a 'new recipe' or 'new improved' flash indicates a recipe change. In the case of anaphylactic reactions information must always be accurate and up to date. Peanut and nut-free lists are often controlled closely and carry a 'Use by'...

Causes of allergic rhinitis

Ers than dogs, but all very small animals such as guinea pigs or hamsters can cause symptoms. Laboratory allergy is a significant problem since rats, mice, guinea pigs and rabbits in an animal laboratory-setting, may quickly sensitize the allergic-prone individual. In a hospital setting, latex allergy occurs in 8-17 of health work personnel. Wherever latex gloves are in use in hospital there will be airborne latex allergen which may sensitize particularly the atopic individual. It must be remembered that ingestants as well as inhalants may cause rhinitis. Traditionally, milk is supposed in some people to cause catarrh but this symptom is difficult to evaluate. Both the mediators of nasal allergy and also the resulting clinical symptoms including nasal obstruction can be measured

Hayfever on the increase

It is remarkable that in 1934 it was found that 3.5 of the Japanese population resident in southern California were found to have allergic rhinitis due to pollen, a disease that had never been recognized in Japan. However, in 1986 not only was the increase recognized, but an incidence as high as 33.3 for children aged between 6 and 17 years had been noted. The major allergen in Japan comes from trees - the Japanese cedar tree. The frequency of allergy to this particular pollen is more common in people living within 50-100 m of a motorway, compared with those living in the country who are surrounded by trees. A decline in pollen concentration during the last two decades has been accompanied by an increase in air pollution. Hayfever is common, according to the Japanese, in people living near motorways. When pollen grains are collected from industrial areas it can be seen that they are coated with a variety of chemicals. It may be that for allergy to develop, additional factors are...

Support organisations for individuals with food intolerance

In October 1993, my 17-year-old daughter Sarah died of an overwhelming allergic reaction after going into a restaurant and eating a slice of lemon meringue pie containing crushed peanuts. Sarah had thought she was only mildly allergic to peanuts and had no idea that an allergic reaction could kill. National newspaper and television reports referred to 'a very rare allergy to peanuts'. But its rarity was challenged by letters which subsequently appeared in a few of the newspapers letters written by the parents of children with nut allergy. What was significant was that these parents had received little medical guidance about their children's allergy they were coping alone. It also became clear there was a similar lack of knowledge and information within the food industry, and manufacturers and retailers had little or no idea that a major issue was about to break. Support organisations working in the field of food allergy and intolerance have many functions, but a major priority must be...

The Dutch Food Intolerance Databank ALBA

ALBA is perhaps the most influential of the food intolerance databanks worldwide. It was established in 1982 by the Agricultural University of Wageningen and became operational in 1984. Since 1988, the databank has been hosted by a division of the government research organisation Netherlands Organisation for Applied Scientific Research (TNO), located in Zeist. ALBA currently holds data on around 500 brands and 11 000 products from 150 manufacturers and retail organisations, representing approximately 25-40 of the total Dutch manufactured food market. The 'free-from' booklets represent just one of the services offered by LIVO - the National Information Centre for Food Hypersensitivity, based in The Hague. As well as distributing over 12 000 'free-from' lists to consumers every year, LIVO provides a telephone enquiry service and produces general consumer information on food allergy and intolerance. ALBA distributes a further 2000-3000 special combination 'free-from' lists to consumers...

Contact Vulvovaginitis

Diagnosis of contact vulvovaginitis is made by ruling out an infectious cause and by identifying the offending agent. Most cases of mild vulvovaginal contact dermatitis resolve spontaneously when the causative agent is withdrawn. For patients with severe, painful reactions, cool sitz baths and wet compresses of dilute boric acid or Burow's solution may afford relief. Topical corticosteroids, such as hydrocortisone acetate, fluocinolone acetonide, or triamcinolone acetonide, relieve symptoms and promote healing. Oral histamines may be helpful if a true allergic reaction is present. If superinfection with C. albicans has complicated the case, it needs to be treated.

Nonimmunological mechanisms

The best example is scombroid poisoning, due to an excessive amount of histamine in some species of fish such as tuna and mackerel.22 Because histamine is a mediator released from mast cells in food allergy, sometimes pharmacological food intolerance due to histamine is confused with allergic-type reactions. In scombroid poisoning, when fish is inadequately refrigerated, marine bacteria convert the amino acid histidine to histamine. This will generate a histamine concentration greater than the body's normal capacity to metabolise and hence the individual will suffer from the full spectrum of histamine effects, including flushes, vomiting and diarrhoea.

The Anaphylaxis Campaign

The Anaphylaxis Campaign, of which I am director, was set up early in 1994 following five well-publicised deaths caused by allergic reactions to peanuts or tree nuts. Those who died included my teenage daughter Sarah, whose death was particularly shocking because her previous allergic reactions to nuts had been mild. As a journalist, I had some expertise in gathering information and there were indications early on that, far from being rare, nut allergy was really quite common. Supported by my MP, Cranley Onslow, I set in motion the beginnings of an awareness campaign. However, I was not alone. Following the intense national publicity, several parents of children with nut allergy came forward and we formed the core group of the Anaphylaxis Campaign. As knowledge of the group spread, we found we were overwhelmed with letters from families similarly affected 60-70 per day in the first few weeks. By early 2000, membership stood at around 5500. Members pay 5 a year. The Anaphylaxis...

Diagnostic Tests Skin Prick Tests

False-positive tests skin prick test reactivity may be present in subjects with no clinical evidence of allergy or intolerance. This is sometimes described as 'asymptomatic hyper-sensitivity' or 'subclinical sensitization.' Whilst many with positive skin prick tests will never develop the allergy, some subjects with positive skin prick tests do develop symptoms later. However, since the test cannot identify those who are going to develop symptoms, the skin test information is of no practical value. 5. False-positive results skin prick test reactivity may persist after clinical evidence of intolerance has subsided. For example, in a study of children with egg allergy, it was noted that 5 out of 11 who grew out of egg allergy had persistently positive skin prick tests after the allergy had disappeared. 6. False-negative tests skin prick tests are negative in some subjects with genuine food allergies. Skin prick tests are mainly used in research studies. The results of skin tests cannot...

Food Labelling Agenda

FLAG (Food Labelling Agenda) is a national consumer pressure organisation launched in June 1997 by a group of concerned food and health writers. The organisation campaigns for 'clear, comprehensive and meaningful labelling on all food and food products' and its first task in March 1998 was to deliver a petition calling for improved food labelling to Downing Street. It won support from a huge number of individuals and organisations, including those with interests in allergy, genetic engineering, infant feeding, heart disease, cancer, vegetarianism, eating disorders and green issues. The accurate labelling of potential allergens is one of FLAG's major concerns. The organisation is steered by Michelle Berriedale-Johnson and Sarah Stacey and their postal address is PO Box 25303, London NW5 1WN. A newsletter is produced for supporters.

Type V hypersensitivity

See also Acute inflammatory reaction Allergens Anaphylatoxins Antiglobulin (Coombs') test Arthus reaction Atopic allergy Autoimmune diseases Blood transfusion reactions Cell-mediated immunity Contact hypersensitivity Delayed-type hypersensitivity Eczema Food allergy Granuloma Hemolytic disease of the newborn Immune complexes Rhinitis, allergic Sarcoidosis.

Epidemiologic Cycles and Transmission Routes

Other non-infectious sources of diarrhea include nutritional causes such as food allergies and intolerances, lactose intolerance being the classic example. Certain intestinal disorders and diseases can also produce diarrhea. The symptoms in these usually produce chronic or recurrent bouts of diarrhea. Opportunistic infections secondary to diseases such as AIDS or any condition that suppresses the immune system can also produce diarrhea.

Hazard Analysis Critical Control Point Systems

Examples include physical hazards (metal, glass), chemical hazards (pesticide residues, undeclared allergenic ingredients), and microbiological hazards (pathogens, parasites). Regulatory agencies have defect action levels such as pits and stems. They do not present a health hazard. Physical hazards have been reviewed.

Idiopathic facial dermatitis of Persian cats

Differential diagnoses usually considered include ectoparasitism, dermatophytosis, food allergy and herpes infection. Various food trials are usually unhelpful, and evidence for the other differentials is frequently not found. There may be secondary bacterial and yeast infections readily demonstrated with skin cytology. The histological changes in skin biopsies include acanthosis, crusting, hydropic degeneration of basal cells and occasional dyskeratotic keratinocytes including the follicular epithelium. An intense mixed superficial dermal infiltrate accompanies the epidermal changes.

Modification Of Milk Composition

The caseins form the curds in cheese, whereas the whey proteins represent a less valuable by-product. Elimination of b-lactoglobulin from milk would benefit cheese production because it inhibits rennin's action on k-casein, 4 and would benefit certain fluid milk consumers because b-lactoglobulin is responsible for some milk allergies. Removal of b-lactoglobulin from cattle is now technically feasible during transfection of fetal fibroblasts that are then used for nuclear transfer. 7

Targets for HIV drug development Traditional classes

Groups at the National Institute of Allergy and Infectious Diseases and Upjohn identified candidate HIV protease inhibitors that demonstrated anti-retroviral activity by inhibiting proteolysis of the HIV-1 gag polyprotein p55 to the structural proteins p24 and p17 20, 21 . Scientists at Roche described a series of peptide derivatives that mimicked the transition-state of the HIV polyproteins and potently inhibited the protease enzyme 22 . Subsequently, saquinavir, ritonavir, and indinavir were identified as compounds that potently inhibited the HIV protease in vitro 23-25 . Clinical trials sponsored both by the National Institutes of Health (NIH) and industry, and conducted by academic clinical researchers, showed these compounds had potent antiretroviral activity 26-28 and conferred clinical benefits, including reductions in HIV-related morbidity and mortality 29, 30 , particularly when used in combination with nucleoside analogues. These results led to the approval in 1995-1996 of...

Crossreactions between foods

Cross-reactivity is due to a reaction to identical or similar protein allergens that occur in more than one food, or in a food and an inhalant pollen. This is different from associated reactivity where two or more food allergens may be seen to be associated epidemiologically. A good example of the latter is the high rate of association between egg and peanut allergy although the allergens are not related. Establishing a cross-reaction requires the demonstration of at least a positive correlation between the magnitude of specific IgE to both foods, and RAST inhibition studies are needed for confirmation. Cross-reactivity is seen at an immunological level when a subject is sensitised to both foods on the basis of positive skinprick or specific IgE testing to both foods. However, often only a smaller proportion will demonstrate clinical cross-reactivity, that is a reaction to both foods on clinical exposure. cross-reactivity between legumes in 49 out of 69 patients (71 ) with atopic...

Imaging Criteria for Radiographic Assessment in Adults

Decisions about radiographic imaging in cases of suspected renal trauma are based on the clinical findings and the mechanism of injury. Since the majority of renal injuries are not significant and resolve without any intervention, many attempts have been made to identify patients who could be spared the discomfort, radiation exposure, possible allergic reaction, and expense of a radiographic evaluation (Miller and McAninch 1995).

Reptiles and amphibians

Poisonous snakes belong to four families, Viperidae or vipers with two subfamilies Viperinae and Crotali-nae, Elapidae or fixed front-fanged snakes, Hydro-phidae or sea snakes including some Australian snakes, and Colubridae or back-fanged snakes. The crotalid venoms are usually toxic to tissues, although there are some species that have venoms with primary neurotoxic activity. The elapid venoms function primarily as neurotoxins some contain factors that react with complement components (e.g. cobra venom factor). In various venoms cytotoxic, cardiovascular, anticoagulant, hemorrhagic, myotoxic, nephrotoxic, autopharmacologic or neurotoxic effects may dominate. Direct host immunologic reactions to reptile and amphibian venoms are unusual. There are now a number of reports that convincingly demonstrate IgE-mediated allergic reactions to reptilian venoms. As can all foreign proteins, venoms induce antibody formation. Individuals who suffer repeated envenomations develop high levels of...

Essential Information

Many mentally retarded patients have multiple medical problems that, either directly or as a consequence of medication side effects, contribute to their acute problem. Therefore, it is essential to get a complete past medical history, an accurate list of medications and doses, and history of prior adverse reactions including allergies. Frequently used medications and associated side effects are shown in T.a.b.l e .3.0.2-2 Often increasing use of prn medications is associated with changes in mental status. Finally, one should ask about the patient's visual and hearing status and the use of assistive devices such as glasses, hearing aids, dentures, and walkers. Nearly 60 percent of mentally retarded adults have significant visual impairments, and they are twice as likely to have severe hearing impairments as nonmentally retarded individuals.1 i2 It is not unusual for someone with hearing or visual impairments to become agitated or withdrawn if an assistive device is lost or...

Introduction importance of biomarkers in demonstrating health benefits

It is becoming generally accepted that several human disorders in the Western world can be linked, at least in part, to a suboptimal diet. Among them we can observe obesity, diabetes, allergy, cardiovascular disease and cancer. Hence, the dairy industry has considerable market opportunities to produce and develop new and better foodstuffs that without doubt could be profitable both for the industry and for society. However, the industry can only achieve this goal if new strategies are developed to understand the basic underlying molecular mechanisms accounting for these problems. Interest in the role of nutrition in health, not just to stay alive but also to stay healthy and improve the quality of life, has grown tremendously during the past ten years. Traditionally, maintaining health has been more a question of treating diseases through medicines. In the future, the possibility to diminish the risk of disease by eating the right food is an interesting opportunity for the food...

A A Biological Clock in Hypothalamus

Evidence that the hypothalamus is involved in the control of sleep emerged from a large literature dating to the early 1900s. Lesion studies correlating anterior hypothalamic damage with insomnia and caudal hypothalamic damage with somnolence were particularly informative. These and subsequent studies resulted in the concept of hypothalamic sleep centers. A fascinating recent literature has demonstrated a cellular basis for hypothalamic influences on sleep and also provided insights into the means through which temporal organization is imparted on this behavior. It is now apparent that at least two distinct populations of neurons in the rostral and caudal hypothalamus are responsible for the hypothalamic effects on sleep. Using a creative experimental approach, it was demonstrated that neurons in a circumscribed region of the preoptic area the ventrolateral preoptic nucleus (VLPO) in rats express Fos, the protein product of the protooncogene c-fos, shortly following the onset of...

Systemic Pharmacologic Agents

Hydroxyzine is an Hrreceptor antagonist that is indicated for anxiety and allergic pruritus it also has sedative properties. Hydroxyzine has no analgesic action. It is available in oral and IM preparations (dosage 0.5 mg kg oral or IM) IV administration is not recommended. It should be considered as a second-line drug to benzodiazepines, and IM injections generally should be avoided for pain-control medications. Promethazine (Phenergan) is also an H rreceptor antagonist, with sedative, anxiolytic, and antiemetic properties, in addition to providing relief of minor allergic conditions. It is not recommended for children less than two years of age. Promethazine can be given orally, rectally, IV (slowly), or IM. The evidence to support a synergistic analgesic effect of H -,-antagonists with opioids is limited, and they may potentiate the sedative effects of opioids.

Antimitotic Activity of Lunasin

It was estimated that commercial soy products contain about 5.48 mg lunasin g of protein (defatted soy flour) to 16.52 mg of lunasin g protein (soy concentrate) (10). However, it is not known whether ingestion of soy products at the FDA recommended daily consumption of 25 g of soy protein (75) will be adequate for chemoprevention. Bioavailability studies of natural and recombinant lunasin are needed to determine the physiological doses of lunasin that will be effective for preventing cancer. At present, the biological role of the methionine rich protein GM2S-1 or lunasin in soybean seeds is not known. Its allergenic potential has also not been established. Lunasin with identical structure and anti mitotic properties has also been isolated from barley (76).

The Course of Infectious Diseases

Printable Jewelry Design Grids

As distinct from other human pathologies, infectious diseases are characterized by specificity of the living microorganism causing the disease, its transmissibility from a diseased human or animal to healthy people, epidemic dissipation among population under certain conditions, the cyclic character of the clinical course with specific symptoms characteristic of a given particular disease, development of immunity in those who sustained the disease, development of allergy to a given causative agent, and persistence of the carrier state in some infectious diseases after clinical recovery.

The use of disclaimers on food labels

Faced with the fact that tiny traces of certain allergenic ingredients may trigger a severe reaction in susceptible people, food companies have decided that in the case of some products it is impossible to guarantee safety. The warning 'may contain nut traces' is now a common feature of food packaging. The layman who is unfamiliar with the way food companies operate may wonder what it's all about - how do the nut traces get there and why bother to declare them Most people who are allergic to nuts understand that the issue arises from what food technologists call 'cross-contamination' -where a product going down the production line inadvertently comes into contact with something that went down the same line previously. If food companies are willing to come clean about this, surely people with allergies should be grateful for any warning that protects them. The truth is that some are indeed grateful, but many have become exasperated by the increasing...

Papulocrusting dermatitis miliary dermatitis

Miliary dermatitis is a cutaneous reaction pattern a response to a variety of stimuli that induce self trauma and overlicking. The principal differential diagnosis is flea-bite hypersensitivity other allergic causes include food allergy, atopy and possibly intestinal parasite hypersensitivity, although the latter is considered exceptionally rare. Infectious causes include dermatophytosis and bacterial folliculitis. Parasitic causes may include lice, Cheyletiella, Otodectes and trombiculid mites. Rare causes include EFA deficiency and hypereosinophilic syndrome.

Erythema multiforme and toxic epidermal necrolysis

The immune mechanisms involved in contact dermatitis are assumed to include delayed type IV hypersensitivity reactions, in contact allergy, to be distinguished from contact irritant dermatitis where there is direct damage to epidermal keratinocytes. In either situation contact dermatitis appears to be rare in cats. Contact irritant dermatitis may range from epidermal oedema to a chemical burn, and could be associated with acids, alkalis, surfactants, solvents and so on. Contact allergens are poorly determined in veterinary dermatology and are assumed to involve low molecular weight lipid-soluble molecules that can act as haptens. The histopathological findings in contact dermatitis may be indistinguishable between irritant and allergic. The latter may involve an epidermal spongiosis with a neutrophilic superficial interstitial dermatitis.

Bernard E Bulwer MD MSc and Scott D Solomon MD

At the time of presentation, his medications included captopril, lasix, digoxin, potassium chloride, aspirin, multivitamins, and unspecified dietary supplements. He had no known drug allergies. His family history was significant for coronary heart disease. He smoked more than two packs of cigarettes daily for more than 20 yr, and averaged almost a quart of alcoholic beverages of various descriptions. He admitted no intravenous drug use, but occasionally used cocaine.

Differential Diagnosis

Drug seekers may present with factitious episodes of renal colic. They can be remarkably inventive in the complexity of their ruse, and there is no specific method of detecting them. A history of multiple medical allergies to nonnarcotic analgesics and radiocontrast media is frequently given. Such patients may report having a known radiolucent stone and may simulate hematuria by placing blood in their urine. The vital signs may suggest this behavior if changes in blood pressure and heart rate do not match the extreme discomfort demonstrated. When the clinician is unsure, it is better to give analgesia than to deprive a patient suffering from true renal colic.

Collaboration with governments

For many years, food allergy and intolerance had a poor public image. Despite the progress made in this field by a small number of dedicated scientists and physicians, allergy found itself on the fringes of medicine, dismissed altogether by some doctors, who regarded it as a convenient scapegoat for undiagnosed conditions that had other, unknown causes. People who claimed to suffer adverse reactions to food were accused of jumping on to an allergy bandwagon. Perhaps these accusations were justified in some cases, but many doctors threw out the baby with the bathwater. The cause was not helped by articles published by lightweight glossy magazines, which made extravagant claims about food allergy which plainly had little basis in science but were merely sensationalist. However, all this began to change in late 1993 when five deaths triggered by allergic reactions to peanuts or nuts received widespread national publicity. Almost overnight, allergy became a serious issue. The death of my...

Chapter References

Ann Allergy 69 87, 1992. 4. Ditto AM, Harris KE, Krasnick J, et al Idiopathic anaphylaxis A series of 335 cases. Ann Allergy Asthma Immunol 77 285, 1996. 9. Coombs RRA, Gell PGH Classification of allergic reactions responsible for clinical hypersensitivity and disease, in Gell PGH, Coombs RRA, Lachmann PJ (eds) Clinical Aspects of Immunology, 3d ed. Oxford, Blackwell Scientific, 1975. 12. AAAI Board of Directors Position Statement The use of epinephrine in the treatment of anaphylaxis. J Allergy Clin Immuno 94 666, 1994. 16. Cicardi M, Bergamaschini L, Cugno M, et al Long-term treatment of hereditary angioedema with attenuated adrogens A survey of a 13-year experience. J Allergy Clin Immunol 87 768, 1991.

Type I hypersensitivity

The first description of an allergic response was made by Prausnitz and Kustner, who succeeded in provoking an allergic reaction by transferring the serum of Kustner, who was reacting to fish, to Praus nitz, who was allergic to pollen. Reinjcction of fish antigen immediately triggered a wheal and a flare at the site of reinjection. This observation goes back to 1921. It is surprising that the term allergy or atopy (altered reactivity) has become synonymous with a type I hypersensitivity only in more recent times when the term 'allergen' was introduced for proteins and chemicals responsible for this reaction, and the term 'anaphylaxis' was established for the resulting generalized immune reaction. The localized form of anaphylaxis is exemplified by hay fever, asthma, eczema and urticaria (skin wheals). The systemic anaphylaxis characterized by sudden shock and dyspnea, frequently leading to death, occurs in extremely sensitive individuals. mechanisms of antigen processing, the presence...

Topical Agent Vehicle Considerations

The vehicle, or medication base, is the substance in which the active ingredient is dispersed. The base determines the rate at which the active ingredient is absorbed through the skin. Components of some bases may cause irritation or allergy. Creams, a mixture of oils, water, and preservative, are white in color and greasy in texture. Creams are the most versatile vehicle and can be applied to any body surface area they are particularly useful in the intertriginous areas. Creams are best used for acute therapy only chronic application may cause excessive drying. Ointments are composed of greases such as petroleum jelly and are preservative-free little water is added to this vehicle. This vehicle is translucent and, when applied to the skin, remains greasy. This greasy consistency may aid in the lubrication in particularly dry lesions. In general, ointment vehicles allow deeper tissue penetration when compared to the cream base. Ointments are too occlusive, providing very thorough...

Principal Mechanisms and Pathophysiology of Food Intolerance

Food Allergy The term 'allergy' implies a definite immunological mechanism. This could be antibody mediated, cell mediated, or due to circulating immune complexes. The clinical features of an allergic reaction include urticaria (nettle rash), angioedema, rhinitis (sneezing, nasal discharge, blocked nose), worsening of pre-existing atopic eczema, asthma (wheezing, coughing, tightness of the chest, shortness of

Products of the maillard reaction

Premelanoidins have been shown to inhibit growth, cause liver damage, and interrupt reproduction in laboratory animals. Maillard products of fructose-glycine and fructose-arginine increase the mutagenicity of 3-amino-1,4-dimethyl 5H-pyridol-(4,3-b)indole. Antimutagenic effects seem to correlate well with antioxidant effects. However, mutagenicity of benzo(a)pyrene is moderately inhibited by such products. Some products of the Maillard reaction have been shown to induce allergic reactions.

Allergic To Everything

Allergic To Everything

The human body And Todays chemical infested world. Here is a news flash You are not allergic to pollen, pet dander, or whatever it is that makes your body revolt Rather, your body just can not handle that one thing, what ever it is, anymore, due to the massive barrage of toxic chemicals you and everyone else are ingesting every single day.

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