Clinical Nutrition- Exam 1- Food Allergies and Intolerances

What is the difference between food allergy and intolerance

Allergy reacts to certain proteins in the foods

Intolerance is functional disorders

Examples of food allergies

IgE mediated

Non IgE mediated

Mixed IgE and non IgE

Examples of food intolerances

Microbial

Pharmacological

GI

Psychological

Metabolic

Big 9 food allergens

Cows milk

Eggs

Wheat

Soy

Sesame

Fish

Shellfish

Peanuts

Tree nuts

Major food allergens that are most likely to resolve in childhood

Cows milk

Eggs

Wheat

Soy

Sesame

Major food allergies that are most likely to persist into adulthood

Tree nuts

Peanuts

Shellfish

Fish

Most common allergy in kids

Cows milk

How can food allergies be prevented during pregnancy for the child

Do not avoid specific allergens

Fish oils help decrease risk

Probiotics

How can food allergies be prevented during infancy

Breastfeeding for at least 4 moths

No maternal dietary restrictions

SOY FORMULAS NOT RECOMMEND

Infant at high risk for allergies could used hydrolyzed formula for first 4 months

IgE mediated allergic reaction type

Type I

IgE mediated allergic reaction timing

Minutes to an hour

Mixed IgE and Non IgE mediated allergic reaction type

II and III

Timing for mixed IgE and Non IgE mediated allergic reaction

Delayed, longer than 2 hours

Cell mediated allergic reaction type

IV

Non atopic individuals (non-allergic people)

Respond weakly to allergens

Produce mainly IgG antibody

Atopic individuals (allergic people)

Large quantities of IgE antidotes up to 1000-10,000 times more

Which immunoglobulins are involved with food allergies

IgE

Symptoms of Type I allergies

Anaphylactic shock

Flushing of the skin, angioedema, pruritus

Bloating, constipation

Asthma, acute rhinoconjuctivities

What happens in the body during the 2nd exposure to an allergenic protein

Allergen binds to specific IgE

Early phase (5-30 min)=-25 mins vesicles release histamine and proteases

Late phase (2-8 hrs later)= prostaglandins, luekotriens, tumor necrosis factor (TNF), interluekins 4, 5, 13

How are food allergies diagnoses

Cannot diagnose any adverse reactions without a clinical response

Skin prick test

Allergen specific serum IgE measures not s

Elimaintin diet

Oral food challenge (GOLD STANDARD)

What is done initially together to help rule out negative reactions for food allergies

Skin prick test

Serum specific IgE analysis

ELIMINATION DIET AND ORAL FOOD CHALLENGE

Describe elimination diet

About for 2-4 weeks (symptoms should disappear)

Challenge test (symptoms should appear)

Avoid again for 2-4 weeks (symptoms should disappear)

Oral food challenge

Elimination diet for at least 2 week prior to

Feeding of gradually increasing amounts of suspected foods under observation by doctor over hours or days

Must be prepared to treat anaphylactic shock

What do 95% positive predictive values tell us?

IDK

Describe empiric diets

Eliminates from diet for at least 6 weeks:

-cereals, milk, eggs, fish/seafood/peanuts/legumes/soy

Reintroduce 1 food at a time

Response rate of 65-80%

What are unvalidated measures of diagnosing allergies

Basophil histamine release/activation

Lymphocyte stimulation

Facial thermography y

Gastric juice analysis

Hair

Applied kinesiology

Electrodermal test

What are symptoms of eosinophilic esophagitis infants

Feeding aversions

How is eosinophilic esophagits diagnosed

Biopsy of the esophagus

Symptoms of eosinophilic esophagtis toddlers

Vomitting

Symptoms of eosiniphilic esophagits school aged

Abdominal pain

Symptoms of eosiniphilic esophagitis adolescents

Dysphagia

Food impaction

Infants with cows milk allergy should not be given which milks

Goat/sheep

Horse

Beef

What are differential diagnoses of food allergy

Infections

GI issues

Celiac disease

Brush border enzyme problems

Cystic fibrosis

Pancreatic insuffiency

Inflammatory bowel disease

Anatomy defects (Pyloric stenosis)

Metabolic disorders

Drug side effects

How are food intolerances diagnosed

IgE reactions, clinical history, SPT, sIgE, elimination diet, rechallenge

Most liked diagnosed with clinical history, elimination diet plus rechallenge

What are the most common intolerances

Lactose (milk sugar)

Gluten

How is lactose intolerance diagnosed

Lactose hydrogenated breath test

How is gluten intolerance diagnosed

FODMAP (cutting out all the fermentable stuff)

Nutrients of concern for milk allergy

Protein

Vitamin D, B12

Riboflavin

Calcium

Iodine (biggest source of it in the US)

Nutrients of concern for soy allergy

Protein

Fiber

Thiamin

Riboflavin

B6

Folate

Viamtin K

Calcium

Copper

Iron

Magnesium

Manganese

Phosphorus

Potassium

Seleniu

Nutrients of concern for egg allergy

Protein

Riboflavin

Biotin

B12

Selenium

Nutrients of concern for fish allergy

Protein

Riboflavin

Biotin

B12

Selenium

Nutrients of concern for shellfish allergy

Proline

B12

Zinc

Selenium

Magnesium

Nutrients of concern for grains allergy

Carbs

FiBER

Thiamin

Niacin

Magnesium

Manganese

Selenium

RIBOFLAIVIN, FOLIC ACID (if fortified)

Nutrients of concern for peanuts and tree nuts allergy

Protein

Fiber

Riboflain

Niacin

VITAMIN E

Copper

MAGNESIUM

Manganese

Nutrients of concern for rice

Carbs

Niacin

Folate

B6

Magnesium

Managasne

Copper

Zinc

Potential treatments for food allergy? Which is the best?

Ordered from nest to worst

Oral (OIT)

Sublingual (SLIT)

Epicutaneous