European countries that successfully set up new databanks

Greece was the first partner of the project to set up its food intolerance databank, in August 1996. The databank is run by the Technological Educational Institution (TEI) of Thessaloniki and covers eight food additives and ingredients milk, egg, gluten, wheat, soya, sulphur dioxide, benzoates and azo colours. The databank is updated annually and currently they have approximately 400 products listed from 25 companies. The Technical University of Graz (Erzherzog Johann Universitat) established...

Measuring the frequency of adverse food reactions and relating this to the natural history

There are a number of ways of measuring the degree to which a population is affected by a disease process such as food allergy. The best approach depends on the question being asked. Investigators usually measure either the incidence or the prevalence. The incidence is the number of new cases of adverse food reactions developing over a specified time. This is a useful measure when studying causality and possible preventative strategies but it gives little idea of the proportion of the...

Methodological issues 1021 Defining adverse food reactions

There are internationally agreed definitions for adverse food reactions, as have been discussed in Chapter 1. Unfortunately, terms such as 'food intolerance' are still used inconsistently. Thus the term 'intolerance' according to internationally agreed definitions is taken to mean physiological reactions to foods that do not have an immunological mechanism. However the term 'cows' milk protein intolerance' is often used to describe an immunological reaction to cows' milk that is non...

Geographical variations

Data concerning the incidence of adverse food reactions from different countries may shed some light on factors that might be important in the development of adverse food reactions. These factors include genetic, cultural, dietary and other environmental differences. Unfortunately all the cohort studies are from Europe, Australia and the USA, with no comparable data from other countries. However, there are case series from these other countries that allow comparisons to be made between foods...

Information for industry

Publications, CD-ROMs and training materials There is an increasing number of publications and CD-ROMs that act as reference sources for UK, EC or international food legislation. These include the Leatherhead Food RA publications Guide to Food Regulations in the UK, EC Legislation and International Food Legislation Manual, all available in hard copy or in CD format. Traditionally recognised publications such as Bell and O'Keeffe's Sale of Food and Drugs and Butterworths in the UK are valuable...

Food intolerance databanks

Many countries throughout Europe have food intolerance databanks managed by a central group, with information provided by companies. They collate information from various food manufacturers and produce comprehensive lists of products free from the key allergens. In many cases the booklets they produce (milk free, egg free, etc.) are available to health professionals, especially dietitians, who are then able to work with sufferers of food allergy to help them select suitable foods and also meet...

Fruits and vegetables

Vegetables and fruits are staple foods in diets worldwide although the types of vegetables and fruits consumed vary widely. It is therefore not surprising that considerable geographical variations exist in respect of adverse reactions to specific fruits and vegetables. Vegetables, and more particularly fruit, may cause adverse reactions that are either IgE-mediated which most often have their onset after the first few years of life (in contrast to many other foods), or occur via other...

Patch testing

Patch testing is a diagnostic tool commonly employed in the diagnosis of contact dermatitis. This may be irritant or allergic in origin. It may be difficult and even artificial to distinguish between these two. Irritants make up about 80 of the problem, and an allergic cause can be attributed to about 20 of patients with contact dermatitis. It is rarely used in the investigation of systemically induced food allergies.12 Patch testing infants suffering from eczema with cow's milk may hold some...

Diet and behaviour problems

In children, food intolerance has been implicated in hyperactivity or behaviour disorders. It has been claimed by some that children's behaviour improved on a food diet containing few or no additives. Parents often strongly believe that food additives, especially azodyes (e.g. tartrazine), are responsible for the child's behaviour. However, scientific proof is lacking and studies have not been able to prove conclusively the effectiveness of the dietary approach. There are considerable problems...

Types of foods available

Allergic reactions require large protein molecules (antigens) to stimulate the production of antibodies. To reduce allergenicity, the source protein can be broken down into small peptide molecules and amino acids by enzyme hydrolysis. This process has been used successfully in the production of hydrolysed formulae (HF). These infant formulae are based on animal or vegetable protein (casein, whey, soy and bovine collagen) and are used extensively in children with cow's milk allergy or...

Migraine and headaches

Occasionally foods with a high content of tyramine, such as cheese, coffee, red wine and yeast extract, are responsible for migrainous headaches.19 In some patients the association is obvious and these patients usually avoid these foods. In other cases of chronic headache, once other treatable causes have been excluded, a diet excluding foods with high tyramine content may be tried. However, double-blind challenges are often unsuccessful in confirming a relationship of foods with headaches.

Approach to food avoidance

Once the diagnosis of food allergy or intolerance has been made, avoidance of the offending food (or foods) is the most important treatment.5 The diagnosis of food intolerance is not always easy, as patients often tend to blame foods for Fig. 5.1 Algorithm for the management of food tolerance. Fig. 5.1 Algorithm for the management of food tolerance. many symptoms that are both related and unrelated to food and there is no test which can reliably exclude or confirm the condition. The approach to...

Implications of study design

In deciding on which study to use to estimate the prevalence of food allergy statistical, practical and financial constraints must be considered. The ideal sample would include all the individuals in the population but this is clearly impossible and our studies must be conducted on a subset of the total population. It is this down-sizing that leads to important methodological problems due to the selection procedures. The different types of study described below represent different selection...

Immunological markers

The role of cord blood total IgE as a marker for the development of food allergy is not clear. Studies do not consistently show a positive association (Dean 1997, Kjellmann et aJ. 1988, Kulig et aJ. 1999). Furthermore, in the recent German multicentre allergy study where an association between cord blood total IgE and sensitisation to foods at one year of age was found, the authors comment on the poor predictive performance of cord blood IgE (Kulig et aJ. 1999). This study puzzlingly also...

Maternal intervention

The potential for in utero sensitisation to food allergens via the placenta or swallowing of amniotic fluid has led to a number of investigators restricting possible antigens in the maternal diet during pregnancy. The potential for sensitisation during lactation also exists as small amounts of food allergens have been found in breast milk. Beta-lactoglobulin is found in the breast milk of 95 of mothers consuming cows' milk during lactation (Host et al. 1988). Peanut and other proteins have also...

Atopic eczema

A proportion of young children with atopic eczema show an improvement when selected foods are excluded from their diet.16 Common foods implicated in the causation of eczema are egg and milk, and in some cases wheat and peanut. A detailed history and skin prick tests or RAST are sometimes helpful in identifying the food, but a negative test does not exclude the possibility of benefit from a food exclusion diet. If the child is sensitised to one or more foods on skin test or RAST, a trial diet...

Food additives

The commonest food additives thought to cause adverse reactions are tartrazine (E102), sunset yellow (E110), annatto, aspartame, benzoic acid and sulphites (Fuglsang et al. 1993). Key epidemiological studies are shown in Table 10.9. Adverse reactions to food additives can occur at any age. A UK study showed a higher reporting of adverse reactions to food additives in the first ten years of life, and more often occurring in females (Young et al. 1987). The mechanism of the reaction is often...

Urticaria and angioedema

In some patients, chronic recurrent urticaria and angioedema can be due to intolerance to food additives.17 Other causes include drugs, physical factors (cold, pressure, heat, etc.) and foods. However, it should be remembered that no cause can be found in the majority of patients (idiopathic chronic recurrent urticaria). An attempt should be made to identify a cause. If a drug or a food is found to be causative, this should be excluded. In cases where no cause is obvious, the best approach is...

Eczema

Eczema can be part of a late phase IgE-mediated reaction or a delayed immune reaction to allergen, not mediated by IgE. Eczema is a common feature in people who do not have positive skin prick tests or IgE tests to the allergen. It is therefore only on the basis of a clinical improvement on exclusion of the food and relapse on reintroduction that the diagnosis can be made. Usually the only clinically useful test is an exclusion diet. Patch testing is being investigated as a diagnostic tool for...

Application to the diagnosis of food allergy

Foodstuffs are an uncommon cause of immunologically mediated contact dermatitis, although regular contact with vegetables and meat can certainly irritate intact or eczematous skin. Plant-derived saps such as from poison ivy and poison oak can cause a characteristic contact dermatitis. There exists cross-reactivity with these saps and mango skin and the oil from cashew nut shells. Some clinicians claim an exacerbation of eczema atopic dermatitis in patients who are patch test positive to nickel,...

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...

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...

Immunological mechanisms

These reactions are the most frequent, the best known and the easiest to diagnose. They occur when an individual is already sensitised. In susceptible individuals, when a food allergen is encountered for the first time, the adaptive response initiates production of IgE antibodies. IgE antibody production itself is regulated and depends upon compounds known as cytokines. Once IgE antibodies are produced, they will bind to mast cells. This process, known as sensitisation, precedes symptoms 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...

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...

Past medical and drug history

The patient's full past medical history, including drug history, should be documented, including other allergic and all non-allergic illnesses. The possibility of a psychiatric history should be considered. Some clusters of symptoms at presentation are more likely to be linked with psychiatric diagnoses. People presenting with multiple symptoms, and concerns over many foods and other environmental problems, have been shown to be more at risk of symptoms of depression or anxiety.10 Parents may...

Examination

A general examination of all the major systems of a patient normally supplements the clinician's history taking. In the case of paediatric examination, in particular, it should include the measurement of parameters of growth -height, weight and head circumference - which should be recorded on an appropriate centile chart. Chronic illnesses such as coeliac disease and poorly controlled asthma may result in a thin, short child, as do the use of long-term high-dose steroids. The examination of the...

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 -...

The practical application of due diligence to food allergenicity

The key to practical implementation of the 'due diligence' defence is knowing your product. Modern foods are complex and will rarely be manufactured from a handful of fresh ingredients derived from known sources. Frequently, complex flavouring compounds and other bought-in functional ingredients will be used in order to provide the specific manufacturing properties and product attributes which are necessary to make a product successful in today's competitive world. It is therefore important to...

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 The typical...

The diagnostic pathway

Diagnostic tests for food allergy, as with all medical tests, cannot be discussed in isolation. They are only one part of the whole diagnostic pathway. When an individual presents a particular problem to a health professional, a diagnostic pathway is embarked upon. This pathway starts with the professional taking the individual's medical history, the story of their particular problem. This is often complemented by an examination. The pathway may or may not conclude with particular tests. All...

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...

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...

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...

The accuracy of diagnostic tests

Every disease has a rate of prevalence and incidence within both the general population and specific populations. The term 'prevalence' is a statistic based upon a particular point in time. It refers to the number of cases of a particular disease divided by the total number of people within the population and is usually represented as a percentage. 'Lifetime prevalence' is the number of people within a population who may have a particular disease at some time in their life, expressed as a...

Other nonIgE antibodies

The body also is capable of producing other types of antibodies such as IgM, IgG and IgA against foods. Some studies have claimed a role for IgA-secreting cells, which have been shown to rise after ingestion of a particular foodstuff, or IgG4 that is said to correlate with clinical hypersensitivity. No studies have been able to demonstrate the role of these antibodies in the pathophysiology of food allergy. Food-specific non-IgE antibodies seem to be much more likely to reflect the particular...

Introduction the law and food intolerance

The results of a food intolerance condition can vary from mild discomfort through severe pain to tragedy. How can the law help to regulate this situation and protect the consumer whilst providing a framework in which business can operate How successful is it in achieving this objective Throughout history laws have existed to protect the consumer against the adulteration of food, whether deliberate or accidental. Watering down of milk and the contamination of food with heavy metals have long...

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...

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...

The legal background labelling

The practical protection which individuals with food allergy and intolerance can expect from the law is information rather than elimination. To this end, comprehensive food labelling requirements have developed. Throughout the European Union these requirements are largely harmonised and stem from EC Directive 79 112 on the labelling and presentation of foodstuffs. The provisions are enacted within the UK as the 1996 Food Labelling Regulations. Although it originated two decades ago, the...

Other symptomatic treatment

Ketotifen with antihistaminic and anti-inflammatory properties has been used in food allergic reactions such as urticaria and bronchospasm. It may be useful as an additional therapy in some patients. Beta-2 agonists such as salbutamol or terbutalin may be used when bronchospasm is a prominent feature in an allergic reaction. These drugs can be delivered by inhalation through a metered dose inhaler, in an aerosol form through a nebuliser, or by intravenous route. Food-related eczema and rhinitis...

How common is anaphylaxis

Much local data has been collated in order to try to gain estimates of how common anaphylaxis might be. Yocum and Khan22 estimated that food caused one-third of anaphylactic reactions that occurred outside hospitals in the US. Danish data suggest prevalence of one in 30 000 population per year.23 A prospective study by Bock in Denver, Colorado, found 25 cases of food-related anaphylaxis over a three-year period, a third of which were due to peanut.24 This number of reactions in a state whose...

Severe allergic reactions

Following assessment of severity, if the reaction is not thought to be immediately life-threatening, antihistamine and hydrocortisone may be given while the patient is observed in a medical facility. 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....

Is laryngeal oedema a moderate or severe symptom

The larynx is the narrowest part of the upper airway. Clearly, therefore, any change in the diameter of the larynx (by oedema) is going to have a significant impact on airflow and tissue oxygenation. The distinction between laryngeal Table 4.4 Association of severity of first reaction to peanut and presence of asthma oedema and swelling above the larynx in the back of the throat can be very difficult. In general, laryngeal oedema is characterised by noisy breathing, a change in the character of...

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,...

Intervention strategies aimed at preventing adverse food reactions

Most of the work in this area has been directed at preventing allergic sensitisation (primary prevention), rather than the prevention or suppression of clinical disease once sensitisation has occurred (secondary and tertiary prevention respectively). Up to now, no therapy has been shown to be of value in secondary or tertiary prevention of adverse food reactions. Furthermore, whilst some studies show that pharmacological intervention may alter the incidence and natural history of asthma, there...

Background to the European Food Intolerance Databanks project EFID

The European Food Intolerance Databanks project developed as a result of the success of the food intolerance databanks in the Netherlands and the UK. In the early 1990s, the Leatherhead Food RA was aware that, despite the usefulness of food intolerance databanks in the management of food intolerance, the UK and Dutch databanks were the only ones in existence in Europe. After considerable consultation with experts, Leatherhead submitted a proposal to the Commission of the European Communities...

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 susceptibility be due to genetic factors What about environmental factors, in particular during infancy What is their impact 4 What role do food allergens themselves play We know...

Occupation and smoking

Respiratory diseases have known associations with those working in the food and food-related industries. These include occupational asthma, occupational rhinitis and hypersensitivity pneumonitis. Skin diseases such as contact dermatitis and contact urticaria are also associated with work in these industries. These diseases are not all Type I, IgE-mediated reactions. Some cases of occupational asthma and some of contact dermatitis occur as a result of irritation.12 Hypersensitivity pneumonitis...

Avoidance therapy 521 General principles

The diagnosis of food-related symptoms should not be taken lightly, as food avoidance can be difficult, expensive, disruptive and even harmful to the health of the patient, especially in infants and young children1 (Table 5.1). The increasing complexity of our food intake and a higher proportion of packaged cooked foods in our diet make the avoidance of a particular food difficult (Table 5.2). The food industry has become increasingly important in the lives of patients with food allergy and...

Open patch test and the diagnosis of contact urticaria

Some food substances can induce an immediate urticarial-type reaction at the point of contact. No standardised test exists for investigating such contact urticaria, but one can demonstrate such a reaction by an open test. The substance is placed on the skin of the flexor surface of the forearm for 30-45 minutes in an attempt to replicate the urticaria. It may be necessary to use non-intact, eczematous skin. This contact urticaria may be secondary to an allergic or non-allergic reaction. In the...

Characteristics of patients with food intolerance

The most widely quoted study is by Parker et al. They were able to divide 45 adults reporting food-related complaints into two groups. The first group of 22 subjects reported reactions to the common allergenic foods - legumes, tree nuts, crustaceans and fish. Twenty-one out of the 22 subjects in this group had positive skin prick tests to the offending food. The second group reported reactions to food such as sugar, wheat, egg, cured meat and yeasts. Only four out of the 23 subjects in group 2...

Collaboration with the food industry retail and manufacturing

Soames's statement that any change in labelling legislation is a European matter is quite true. That prospect was an alarming one for campaigners who were concerned about food-induced anaphylaxis and the risks of allergy sufferers inadvertently coming into contact with lethal ingredients. Soames seemed to be implying that it would be several years before all prepacked food would be adequately labelled and therefore safe. A major point for discussion was the 25 rule governing compound...

The epidemiology of adverse food intolerance

Lack, St. Mary's Hospital, London 10.3 Commonly reported food allergies 10.5 Cross-reactions between foods 10.7 Risk factors for the development of adverse food reactions 10.8 Intervention strategies aimed at preventing adverse food reactions

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...

Toxic food reactions

Classification Adverse Reactions

In principle, these are reactions which could occur in any individuals if the dose is high enough to trigger a reaction. They are usually caused by direct action of food components without involvement of immune mechanisms. Toxic compounds which trigger such reactions can occur naturally, such as from eating a puffer fish complete with its poison sac Or they can be contaminants of food. Although such reactions are fairly distinguishable from non-toxic food reactions in terms of mechanism, one...

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...

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...

Peanuts and tree nuts

Over the last few decades, peanuts have become a ubiquitous part of the Western diet as they are a versatile form of easily digested protein (Lucas 1979). In a study looking at the use of dietary manipulation to prevent the development of food allergy, all infants in the control group were exposed to whole peanuts by their second birthday (Zeiger et al. 1989) occult exposure probably occurs even earlier. Adverse reactions to peanuts and tree nuts are generally IgE mediated, occurring rapidly...

The catering industry

So far I have concentrated on food sold in supermarkets, but it has to be accepted that the greater risks for people with severe allergies lie in catering establishments, where the owners are under no legal obligation to label allergenic ingredients. Most of the known deaths from food-related allergies have occurred when the food was eaten away from home. Although information on near-fatalities is largely anecdotal, it is almost certain that most of these incidents happen when food is eaten in...

Nontoxic food reactions

These reactions are either immune-mediated or non-immune-mediated. When the reaction is immune-mediated the term 'food allergy' is applied, and when non-immune-mediated the term 'food intolerance' is recommended. Both types of reactions are reproducible and depend on an individual's susceptibility. Food allergy itself can be subdivided into two categories, IgE-mediated food allergy and non-IgE-mediated food allergy (Fig. 1.1). Immunoglobulin (Ig) E, or IgE, is the main antibody involved in...

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 Table 5.6 Foods commonly implicated in the anaphylactic reactions Tree nuts brazil nut, hazelnut, almond,...

References

1 ISOLAURI E and TURJANMAA K, 'Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis', J Allergy Clin Immunol, 1996 97 (1) 9-15. 2 SACKETT D L, RICHARDSON W S, ROSENBERG W and HAYNES R B, Evidence-based Medicine, Churchill Livingstone, New York, 1997. 3 METCALFE D D, 'Food allergy in adults'. In Metcalfe D D, Sampson H A and Simon R A (eds), Food Allergy Adverse Reactions to Foods and Food Additives, Blackwell Science, USA, 1997. 4...

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...

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 symptoms involving skin and airway significant fall in blood pressure or loss of consciousness. 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...

Hypoallergenic milk formulae7

CMA in the first year of life is one of the most common problems faced by paediatricians. It is mediated by an immune mechanism, whereas cow's milk intolerance is due to non-immunological causes such as lactase deficiency. CMA may affect the gastrointestinal tract, respiratory tract, skin or blood, and systemic reactions, including anaphylaxis, may occur. Avoidance is the mainstay of treatment, and breast-feeding should be actively encouraged. Since intact cow's milk protein can pass into the...

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...

The use of disclaimers on food labels

In February 1994, one of the founder members of the Anaphylaxis Campaign gave a shrewd warning about the possible negative effects of any food labelling campaign companies would begin to take the easy way out by printing disclaimer notices. A leading chocolate company had already begun to include a warning under the ingredient list of two of its brands stating 'May on rare occasions contain nut traces.' And dire warnings were given that this might conceivably catch on. The prophecy has come...

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...

Predisposing factors for anaphylaxis

It is clearly established now that pre-existing asthma may exacerbate or predispose to anaphylaxis. This is clearly in keeping with the concept of the target organ of the reaction being important. Sampson's group of fatal and nonfatal reactors were clearly distinguished by the presence of a diagnosis of asthma, particularly if the asthma was poorly controlled. Our study in Southampton has supported this finding Table 4.4 .10,21 Other factors that may predispose to severe disease are the use of...