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ALLERGIES, FOOD.
Term Paper ID:20467
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Essay Subject:
Types, reactions, diagnosis, treatment.... More...
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6 Pages / 1350 Words
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Paper Abstract:
Types, reactions, diagnosis, treatment.
Paper Introduction:
The Treatment of Food Allergies
Food allergies are characterized by an abnormal or exaggerated immunologic response to specific food allergens resulting in disease (Sampson et al., 1992, 2840). The incidence of food allergy or hypersensitivity is difficult to determine. By some estimates, 4% of infants and 1% of adults are sensitive to some foods or food additives (Cerrato, 1992, p. 73). These numbers translate into millions of cases of hives, eczema, and asthma--along with migraine headaches, insomnia, and a variety of other associated symptoms (Cerrato, 1992, p. 73). The primary treatment for the affliction is dietary avoidance (Pastorello et al., 1989, p. 475). In addition, several drugs have also been used to modify food allergy symptoms (Sampson et al., 1992, p. 2844). Of all the various treatments each has its own
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Sampson, H.A.; Metcalfe, D.D. Patients often present with diarrhea, weight loss,and vomiting (Sampson et al., 1992, p. 2842). 2842). FEMS Microbiology Letters, 79, 489-495.----------------------- 1 Metcalfe, D.D. Recurrence ofsymptoms within 1 to 8 hours constitute a positive challenge (Sampson etal., 1992, p. The diagnosis of any food allergy typically involves a thoroughhistory, selective skin tests (RASTS, if an IgE-mediated disorder issuspected), an appropriate exclusion diet, and a blinded provocation(Sampson et al., 1992, p. 691)--have been extensively characterized(Metcalfe, 1991, p. 2842). The prevalence of food hypersensitivity is greatest early in life(Sampson et al., 1992, p. These include Hl and H2antihistamines, ketotifen fumarate, and corticosteroids (Sampson et al.,1992, p. RN, 55,73-75. This diseasegenerally presents in infants between 1 week and 3 months of age, withprotracted vomiting and diarrhea (Sampson et al., 1992, p. Other non-IgE-mediated food hypersensitivities include celiac diseaseand dermatitis herpetiformis (Sampson et al., 1992, p. 2844). Theavoidance of foods which induce a positive response on double-blindcontrolled challenge will often lead to substantial improvement of thedermatitis (oranje et al., 1992, p. In addition, it appears difficult,if it is not impossible, for patients to eliminate hypersensitivity tofoods like peanuts and other nuts (Pastorello et al., 1989, p. 492-493). 2844). 2842). Finally, oral allergy syndrome is yet another IgE-mediated reactionassociated with food ingestion (Sampson et al., 1992, p. 2842).Elimination of the responsible allergen usually leads to resolution ofsymptoms within 72 hours (Sampson et al., 1992, p. Finally, one other food-induced hypersensitivity reaction is themigraine headache (Sampson et al., 1992, p. 284 ).The means by which this occurs are not well understood (Sampson et al.,1992, p. 2843). These numbers translate into millions of cases ofhives, eczema, and asthma--along with migraine headaches, insomnia, and avariety of other associated symptoms (Cerrato, 1992, p. 882). 2842). 2843). Food immediate-contacthypersensitivity (FICH) and elimination diet in young children with atopicdermatitis. 73). 2843). 2842). The clinical manifestations of food allergy are variable. (1989, October). 882). In general, they resultfrom cow's milk sensitivity, but may also be caused by sensitivity to sow,egg, or wheat proteins (Sampson et al., 1992, p. Clinical and Experimental Allergy, 2 ,689-692. 2844). Symptoms--which may include tingling, pruritus, and angioedema of the lips within 5to 3 minutes after exposure--are generally also precluded by foodavoidance (Sampson et al., 1992, p. (1993, January). 2844). 883). In general though, these varioustherapeutic modalities have proven ineffective (Sampson et al., 1992, p.2844). 284 ). 2842). 2844). 44). Strict elimination of the offending allergen is the only proventherapy once the diagnosis of a particular food hypersensitivity has beenestablished (Sampson et al., 1992, p. The incidence of food allergy orhypersensitivity is difficult to determine. Stewart-Tull, D.E.S., & Jones, A.C. Oral foodchallenges consist of administering up to .6 g/kg body weight of thesuspected protein allergen (Sampson et al., 1992, p. 2842). Increased susceptibility of young infants to food allergicreactions, however, is believed to partially result from immunologicimmaturity and concomitant lack of such tolerance (Sampson et al., 1992, p.284 ). Parker, S.L.; Krondl, M.; Coleman, P. For example, drugtreatments tend to have low efficacy and may produce undesirable sideaffects; whereas elimination diets may cause malnutrition and eatingdisorders (Sampson et al., 1992, p. 2842). 2843). Celiacdisease is a more extensive enteropathy leading to malabsorption (Sampsonet al., 1992, p. The management of patients who suffer immediate reactionsinvolves the identification of the foods in question and their removal fromthe diet (Metcalfe, 1991, p. 2844). 73). Food-induced malabsorption syndromes also present in the first fewmonths of life (Sampson et al., 1992, p. Inany case, solid foods should be avoided until 4 months of age (Sampson etal., 1992, p. (1992). (1992, October). The Treatment of Food Allergies Food allergies are characterized by an abnormal or exaggeratedimmunologic response to specific food allergens resulting in disease(Sampson et al., 1992, 284 ). Moreover, oral cromolyn sodium, injection immunotherapy,and subcutaneous provocation and neutralization have also been tried(Sampson et al., 1992, p. 284 ). 2841). Food allergies.JAMA, 268, 284 -2844. 2842). Furthermore, a significantnumber of children and adults may also lose their clinical reactivity after1 to 2 years of allergen avoidance (Metcalfe, 1991, p. Another food-specific disorder mediated by IgE antibodies is allergiceosinophilic gastroenteritis (Sampson et al., 1992, p. 2841). A number of food allergens--of which many crossreact(Fiorini et al., 199 , p. Current Opinion inImmunology, 3, 881-886. Oranje, A.P.; Aarsen, R.S.R.; Mulder, P.G.H.; Van Toorenenbergen,A.W.; Liefaard, G.; Dieges, P.H. 73). In addition, several drugs have also been used to modify foodallergy symptoms (Sampson et al., 1992, p. Mothers who don'tnurse, however, can also use hypoallergenic formulas with high-risk infants--i.e., those with a family history of allergies (Cerrato, 1989, p. 882). These implicationscan become more significant when such diets include a large number of foodsand are employed over extended periods (Sampson et al., 1992, p. Roleof the elimination diet in adults with food allergy. Foodsperceived by adults as causing adverse reactions. Challenge consists of reintroducing the suspectedfood allergen and demonstrating a recurrence of symptoms (Sampson et al.,1992, p. 2842). 2842). 41). Treatment consists of life-long elimination of gluten-containing foods (Sampson et al., 1992, p.2842). Other allergens implicated in the enteropathy include cow's milk,soya bean, ovalbumin, and wheat protein antigens (Stewart-Tull et al.,1992, p. Allergicreactions caused by food-specific IgE antibodies tend to be immediate(Metcalfe, 1991, p. 73). 482). Patients must be taught toscrutinize food labels to detect potential sources of food allergens(Metcalfe, 1991, p. These reactions often involve thegastrointestinal tract (nausea, vomiting, and diarrhea), the skin (hivesand angioedema), and the circulatory system (hypotension and, ultimately,systemic anaphylaxis) (Metcalfe, 1991, p. The primarytreatment for the affliction is dietary avoidance (Pastorello et al., 1989,p. (1992, December 15).Adjuvanted oral vaccines should not induce allergicresponses to dietary antigens. 2842). Fiorini, G.; Rinaldi, G.; Bigi, G.; Sironi, D.; Cremonini, L.M.(199 , November). Although greater than 98% ofingested antigen is blocked by this gastrointestinal barrier, minuteamounts of intact food antigens are absorbed (Sampson et al., 1992, p.284 ). 881). (1992, November 25). The gastrointestinal tract uses both nonimmunologic and immunologicmechanisms to prevent intact foreign antigens from gaining access to thebody (Sampson et al., 1992, p. (1991, December). Eliminationof suspect foods for 6 to 12 weeks generally leads to symptomaticresolution in most cases (Sampson et al., 1992, p. Typically, most individuals develop oral tolerance to the variousfood antigens which enter their system (Sampson et al., 1992, p. For example, it is well-recognized that celiac disease is a life-longsensitivity which requires that gluten-containing cereals be avoided forlife (Sampson et al., 1992, p. Foods which potentially provoke symptoms may be identified from thehistory, skin testing, or radioallergosorbent tests (RASTS) (Sampson etal., 1992, p. Food allergy. In addition, several drugs have been used in the treatment of foodallergies (Sampson et al., 1992, p. 4 ). Symptoms of respiratory allergies are worse in subjectswith coexisting food sensitization. Dermatitis herpetiformis is characterized by a chronic, pruruiticrash distributed over the extensor surfaces of the extremities and buttocks(Sampson et al., 1992, p. Of all the varioustreatments each has its own characteristic drawbacks. IgE-mediated reactions also are thought to contribute to thepathogenesis of atopic dermatitis (Oranje et al., 1992, p. Prescribing an elimination diet, however, is insome ways like-prescribing a medication--it may have potentially importantnutritional implications (Parker et al., 1993, p. Most infants, however, tend to outgrowthe disorder (Sampson et al., 1992, p. In addition, gastrointestinal disordersmay require biopsy studies before and after challenge (Sampson et al.,1992, p. 2841). 882). Studies seem tosuggest that exclusive breast feeding for at least the first six months mayprevent some food allergies (Cerrato, 1989, p. 2844). Acta Dermato-Venereologica Supplementum, 176, 99-1 2. In some persons, symptoms occuronly after eating certain foods, but in other individuals, no specific foodcan be identified; although the association of the meal with exercise canpredispose a patient to anaphylaxis (Metcalfe, 1991, p. It should berecognized, however, that the loss of clinical reactivity is directlyassociated with both compliance and the specific involved allergen(Pastorello et al., 1989, p. These headaches, in general, are also treated with foodavoidance (Sampson et al., 1992, p. Therapy consists of the elimination ofgluten from the diet and, possibly, the administration of sulfones (Sampsonet al., 1992, p. 2841). Patients with severe systemic reactionsmust be prepared to administer epinephrine to themselves after inadvertentexposure to a food to which they are sensitive (Metcalfe, 1991, p. 475). By some estimates, 4% ofinfants and 1% of adults are sensitive to some foods or food additives(Cerrato, 1992, p. Preventing food allergies. This fact mayserve to motivate food allergy towards compliance with their diets(Pastorello et al., 1989, 482). Pastorello, E.A.; Stocchi, L.; Pravettoni, V.; Bigi, A.; Schilke,M.L.; Incorvaia, C.; Zanussi, C. 882). 284 ). With somepatients, however, oral steroids may also be necessary (Sampson et al.,1992, p. 881). Non-IgE-mediated food hypersensitivity disorders include food-inducedenterocolitis syndrome (Sampson et al., 1992, p. 2844). Fatal anaphylactic reactions may progress rapidly or begin with mildsymptoms and then progress to cardiorespiratory arrest and shock over 1 to3 hours (Sampson et al., 1992, p. 882). 2843). References Cerrato, P.L. These antigens are primarily composed of glycoproteins (Metcalfe,1991, p. Journal of Allergyand Clinical Immunology, 84, 475-483. A number of vasoactivesubstances within foods, including tyramine, phenylethylamine, ethanol,nitrites, and caffeine, may precipitate some migraines (Sampson et al.,1992, p. 482).However despitethis, the elimination of many other offending foods can often be followedby their eventual reintroduction (Pastorello et al., 482). 2841). 2842). 2844). 2841). Journal of the AmericanDietetic Association, 93, 4 -44.
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