Food Allergy Survival Guide
Peanuts can leave you breathless. Cat dander can lead to itchy eyes, a stuffy nose, coughing and sneezing. And most of us have suffered through those seasonal allergies with horrible pollen counts. Learn more...
Part II, Mucosal Diseases, addresses the secretory immune system with special reference to mucosal diseases. Section E consists of chapters on the stomach, intestine, and liver, and includes diseases of GALT and intestinal tract, a chain and related lymphoproliferative disorders, gastritis and peptic ulcer, malabsorption syndrome, food allergy, intestinal infections, and diseases of the liver and biliary tract (Chapters 35-42). Section F covers selected areas of lung and lower airway and
Gastronomy is not a world only of pleasurable aromas and tastes. More than one-quarter of the population in seven countries of the European Union claims to suffer from food allergies or intolerances. Although clinical tests indicate that the actual incidence of such allergies is much lower than commonly believed (about 3.5 of the population), these reactions pose a major public health problem, all the more because the seriousness of the attacks reported is on the rise. In the last ten years the number of cases of ana-phylactic shock caused by a food allergy has quintupled, and many of these attacks are fatal, notably ones triggered by the ingestion of products derived from peanuts. The reasons for the recent growth of food allergies are not completely understood. The increase in the number of offending foods seems to be linked to the development of respiratory allergies to plant pollens the antibodies produced by the human organism against a pollen antigen sometimes react also against...
Defined as diarrhea that lasts longer than 4 weeks. Common causes include chronic, nonspecific diarrhea (toddler's diarrhea), lactose intolerance, milk-protein allergy, encopresis, irritable bowel syndrome, various infections, drugs, and IBD. It can present with an acute exacerbation.
Recognized and may take many weeks to recover even after clearance of parasite. Recurrent diarrhoea after treatment for Giardia would rather be lactose intolerance than relapse of infection. Malabsorption in giardiasis is well documented and is also responsible for weight loss as well as failure to thrive. Even when the infection is asymptomatic, malabsorption may occur. Extraintestinal manifestations in unusual cases have been described (Shaw and Stevens 1987 Clyne and Eliopoulus 1989).
Malnutrition can be classified as either primary or secondary 1 . Primary malnutrition is caused by inadequate calorie and nutrient intake. In developed societies, calorie intake is usually presumed to be adequate. However, inadequate intake of micronutrients including vitamins A and E, calcium, iron and zinc are prevalent among children of 1-10 years of age and often unrecognized, especially in minority populations 2 . Primary malnutrition in infants can also occur through child neglect or accidental nutrient insufficiency 3, 4 . For example, a genetic defect impairing zinc transport into breast milk from maternal blood can lead to zinc deficiency in infancy 5 . Eating disorders associated with psychosocial disorder are a common cause for primary failure-to-thrive in children 6 . Other causes include inadequate diet due to food intolerance or imposition of special diets unsuited to growing children. Vegetarian, macrobiotic or vegan diets in children may be associated with low vitamin...
Fatty foods should be avoided. Well-tolerated foods include complex carbohydrates (rice, wheat, potatoes, bread, and cereals), lean meats, yogurt, fruits, and vegetables. Diarrhea often is associated with a reduction in intestinal lactase. A lactose-free milk preparation may be substituted if lactose intolerance becomes apparent.
In adults, stress, hormonal fluctuations, and possibly food allergies may be the cause of acne. Oral contraceptives can cause breakouts. Excess dietary iodine irritates the pores and can induce flareups. Iodine is found in iodized salt, shellfish, seaweed, and fast foods in which an average meal can contain 30 times the RDA, and in milk, which can be contaminated from milking equipment and cow medication.10 Acne may be caused by a deficiency in zinc.
Chronic fatigue syndrome is characterized by profound fatigue that is not alleviated by sleep, and a myriad of other symptoms including impairment of memory and concentration, muscle pain, and swollen lymph nodes. There is no single cause of the illness and a physician should be consulted to explore all possibilities. Causes may be a viral infection, adrenal gland dysfunction, chemical sensitivity, autonomic nervous system disorder, or food allergy.
Newly diagnosed patients with malabsorptive symptoms should adhere to a lactose-free diet for the first few weeks on a gluten-free diet. This time period will allow for healing of the intestinal epithelium and regeneration of intestinal lactase unless the patient has constitutive lactose intolerance in which case the patient should be maintained on a lactose-free diet. Adequate calcium intake must be insured, especially in this latter group of patients, since celiac patients are at risk of osteopenic bone disease 77 . Until their nutritional status is restored,
Adult mammals and most human groups after weaning keep only a fraction of the intestinal lactase activity of neonates (who need it to digest the lactose of breast milk). The persistence of lactase activity in Europeans has been regarded as the exception to the rule, since most human groups are hypolactasic and lactose malabsorbers (56). However, small amounts of dietary lactose, up to 250 mL of milk, can be tolerated by most adult lactose maldigesters. The decrease in lactase in adults is a programed event, and feeding high-lactose diets does not prevent the decrease. The mechanisms of the decline in activity have been studied in rats. As the animal matures, more and more mRNA message for lactase is needed to maintain the decreasing lactase activity in the enterocytes,
Carbohydrates that have not been digested or absorbed reach the colon and become fermented by the resident bacteria. Hydrogen gas is produced and is excreted in the breath. Measuring breath hydrogen thus provides an estimate of whether malabsorption of a sugar or carbohydrate occurs (see also Chapter 57). It was first used to detect lactose intolerance and has since been used in numerous studies on carbohydrate intolerance ( 60). It has a number of weaknesses for example, it gives no indication of the amount of carbohydrate absorbed before the sugar reached the colon, and the hydrogen in the breath is only a fraction of that formed.
Is there a family history of food allergies, cystic fibrosis, or metabolic disease These conditions may be associated with malabsorption and poor weight gain. F. Are there associated symptoms For example, cyanosis may suggest cardiac disease diarrhea suggests infection, malabsorption, or food allergy.
The mechanism of oral tolerance (Mowat, 1987) is usually effective for nutritional proteins, preventing adverse reactions that potentially lead to food allergies. When autoantigens are fed, autoimmune reactions can be suppressed as well, indicating a potential for oral tolerance as a therapeutic approach for autoimmune diseases (Weiner, 1997). Tolerance is mediated by suppressor cells specific for the respective antigen however, the exact mechanisms underlying orally induced suppression are not yet fully elucidated. It is assumed that suppressor T cells recognize the respective antigen and secrete suppressive cytokines, such as TGF-P (Miller et al, 1992), IL-10 (Rizzo et al, 1999 Slavin et al., 2001) (Th3, Tr type), or cytokines belonging to the respective antagonistic Th type of the pathogenic immune response (Weiner, 2001).
Failure to thrive (FTT) can be caused by primary malnutrition, malignancy, and toxin exposure, congenital anomalies (i.e., Bloom's syndrome, Russell Silver syndrome, immune deficiency, GI disorders, and psychosocial eating disorders. For most cases of FTT, the causes can be found with a comprehensive history physical, and limited laboratory studies. Some cases of true FTT have an unknown etiology, with simple under-nutrition due to behavioral abnormalities and inadequate parenting the most common cause. Infants require nutrient rich diets to sustain growth and development. Although rare, exclusively breast fed infants can show signs of growth abnormalities. One cause can be a maternal genetic abnormality in zinc transport into milk, resulting in severe zinc deficiency in the infant 98 . It is widely appreciated that many so-called health food diets and beverages that may be harmless for adults are not appropriate for infants due to their need to maintain continued growth and their...
12 Liu T, Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, Esterly NB, Levy ML, Schachner L, Frieden IJ (2001) Kwashiorkor in the United States fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol 137 630-636 Karlsson MR, Rugtveit J, Brandtzaeg P (2004) Allergen-responsive CD4+CD25+ regulatory T cells in children who have outgrown cow's milk allergy. J Exp Med 199 1679-1688 116 Jarvinen KM, Laine ST, Jarvenpaa AL, Suomalainen HK (2000) Does low IgA in human milk predispose the infant to development of cow's milk allergy Pediatr Res 48 457-462 117 Rautava S, Isolauri E (2004) Cow's milk allergy in infants with atopic eczema is associated with aberrant production of interleukin-4 during oral cow's milk challenge. J Pediatr Gastroenterol Nutr 39 529-535
Certain groups of patients are more likely to have idiosyncratic reactions to RICM. Patients with a history of a prior contrast reaction have about four times the risk of an adverse reaction, and patients with a history of allergies or asthma have about two to three times the risk of an adverse reaction, compared to patients who do not have these histories (1). Shellfish allergy is not a special allergy with respect to contrast media injection but should be managed in the same way as other non-contrast allergies (e.g., peanut, bee sting, or penicillin allergies) (5). In our experience, some patients relate a history of allergy, often to food, that probably is not a true allergy. For example, a stated allergy to milk may, on closer questioning, reflect lactase deficiency and inability to properly digest milk. Some stated food allergies really reflect an earlier episode of food poisoning. There is no evidence that these patients are at increased risk for contrast reactions.
In addition to planning for access for nutrition support preopera-tively, it is also important to discuss transition back to an oral diet. Upper gastrointestinal surgical resection may be associated with significant postoperative morbidity, including dumping syndrome, delayed gastric emptying, prolonged ileus, obstruction, gastroesophageal reflux and post-gastrectomy syndrome (dumping, fat maldigestion, gastric stasis and lactose intolerance) 91, 92 . Manifestation of these complications can lead to weight loss, malnutrition and increased mortality 93 . Preoperative education to inform patients of normal and abnormal postoperative events can assist them to play an active role in their recovery.
Blood pressure is considered high at a reading of 140 90. There are no symptoms of the illness and it is recommended individuals over 40 be checked. Hypertension can be controlled by permanent diet and lifestyle changes this includes reducing stress, maintaining proper weight (not more than 5 lb overweight), and eating foods containing compounds that reduce blood pressure such as celery, garlic, and fresh fruits and vegetables. Having a home monitor is helpful. Smoking, alcohol, refined sugar, food allergies, and high-sodium foods can contribute to hypertension. Some people may need extra calcium to stabilize blood pressure. Some individuals are salt sensitive which causes a rise in their blood pressure. Daily exercises and various stress reduction techniques lower systolic and diastolic blood pressure.
To a limited but important extent, some proteins and large peptides enter intact directly from the gut into the basolateral blood. Absorption of intact proteins or large portions of proteins is a tenable physiologic explanation for numerous diseases involving food allergies and idiosyncrasies. The gut is generally viewed as an impermeable barrier that nutrients cross by active transport or where a break in the barrier occurs through cell injury. Small amounts of some proteins may pass this barrier by several possible mechanisms, such as through leaks between epithelial cell junctions or possibly by transport through uptake into vesicles from the lumen to the submucosal side of the epithelial cells (142). Again, the amount of protein entering intact is small, but it may be important in situations of immune response to the proteins or in delivery of some peptide drugs.
Individuals with a history of food allergy to tropical fruits (such as avocado, kiwi, banana), chestnuts or stone fruits.49 These plants contain several proteins similar, or in some cases identical, to those found in latex. 7. General population. The prevalence of latex allergy in the general population has been reported to range from
The etiology of Crohn's disease and ulcerative colitis has been elusive, and questions regarding the pathogenesis of the disease have led to many proposals, including some related to diet. Over the years there have been theories that a cow's milk allergy was an underlying factor in these diseases. Other related proposals have implicated lack of breast feeding. High sugar consumption and lack of dietary fiber have been suggested to be associated with the occurrence of IBD 19 .
Likewise, foods that require little or no chewing should be chewed thoroughly nonetheless. Eggs are an excellent example. Most people can (and do ) swallow a mouthful of scrambled eggs with very few chews. However, a large clump of unchewed egg in the stomach can often end up incompletely digested. Protein of any kind is especially prone to incomplete processing when too little of its surface area is exposed to the stomach's digestive acids. One of the most common food allergies is an allergy to eggs, and the ease with which eggs can be swallowed without being well chewed probably accounts for this. The less completely a food is digested, the more likely it is that one will develop an allergy to that food or to a component of that food.
Many patients develop a post-Giardia lactose intolerance and present persistent intestinal symptoms but actually have a disaccharidase deficiency (Mclntyre et al. 1986) and usually improve with time and lactose-free diet. The need for treatment of asymptomatic carriers is currently being discussed. Treatment is indicated if reinfection is unlikely. Different opinions prevail about treating asymptomatic individuals when faecal-oral spread cannot be prevented and rapid reinfection may occur, as in day-care centres.
Symptoms of diabetes are excessive thirst and urination due to the excess of sugar in the blood, fatigue, weakness, and slow wound healing. Diabetics are more prone to cardiovascular disease because of faulty fat metabolism. They may have poor circulation, due to the narrowing of blood vessels, which leads to complications involving the feet, eyes, and kidneys, and susceptibility to infections. Inadequate diet, food allergies, viral infections, and stress can aggravate diabetes Type II. During stress, adrenaline levels increase, which causes a rise in blood sugar.
Sinus problems, hay fever, bronchial asthma, hives, eczema, contact dermatitis, food allergies, and reactions to drugs are all allergic reactions associated with the release of histamine and other autocoids, such as serotonin, leukotrienes, and prostaglandins. Histamine release is frequently associated with various inflammatory states and may be increased in urticarial reactions, mas-tocytosis, and basophilia. Histamine also acts as a neu-rotransmitter in the central nervous system (CNS). Upon release from its storage sites, histamine exerts effects ranging from mild irritation and itching to ana-phylactic shock and eventual death.
Active in producing bile acids which keep cholesterol dissolved. Some individuals may be deficient in HCl (stomach hydrochloric acid). Obesity and constipation are risks for forming stones. Food allergies have been shown to precipitate gallbladder inflammation but not stones eggs, onions, and pork are the most common offenders.
Cystitis is a bacterial infection of the lining of the bladder affecting mainly women. It is usually caused by E. coli which travels from the anus through the urethra and into the bladder. Food allergies, vaginal yeast infections, chemical sensitivities, tissue abrasion from friction during intercourse, and a too large diaphragm may increase exposure to bacteria. Stress and oral contraceptives can lower resistance to infection.
Too little fiber and fluids are the most likely cause of constipation others are drugs such as painkillers, antidepressants, antihistamines, and heart medications lack of exercise, stress, anxiety, laxative overuse dull intestinal nerve reflexes pregnancy, and aging due to the loss of muscle tone. If constipation develops suddenly, see a physician as it may be an indication of colon cancer or impaction. Chronic constipation may be triggered by food allergies.
Ulcers usually form in the duodenum, the upper part of the small intestine a peptic ulcer is in the stomach as well as the duodenum and is so called because of the involvement of pepsin, a digestive enzyme. Ulcers are sores that can bleed. They form when there is too much acid for the mucosal lining to tolerate. They are often caused by an infection of the bacteria, Helicobacter pylori food allergies are also a possibility. It is believed that this bacteria releases acids into the area and may also be the cause of gastritis. Antibiotics are necessary for its eradication.
Diarrhea is commonly caused by high osmolar nasogastric feeds, lactose intolerance, or ischemic damage rather than infection. However, the use of antibiotics is often associated with pseudomembranous colitis caused by Clostridium difficile. The correct response is to withdraw antibiotics, thus removing the selective environment for the organism. Most cases will then resolve. If disease is severe, antibiotics cannot be stopped, or there is dilatation of the colon, oral vancomycin or metronidazole should be given.
Insomnia may be caused by anxiety, stress, depression, too much caffeine, overeating, numerous health conditions, and the use of stimulating drugs. Food allergies can cause insomnia and narcolepsy, a condition in which an individual falls asleep suddenly, at any time, and anywhere. Eating carbohydrates 30 minutes before bedtime increases production of serotonin, a neu-rotransmitter that can reduce anxiety and promote sleep. For some individuals, warm milk has Restless leg syndrome and sleep apnea, a condition in which there is intermittent cessation of breathing during sleep that may be caused by a problem in the central nervous system affecting the diaphragm or a blockage in the upper airway, can benefit by weight loss if overweight and by regular exercise. Caffeine, drugs, and alcohol should be avoided and stress reduced. Food allergies or a deficiency of iron or folic acid may be a factor in restless leg syndrome taking 200 to 800 IU vitamin E can alleviate symptoms of the...
Allergic response to gluten, characterized by proximal small bowel mucosal damage and subsequent malabsorption. Can occur at any time after gluten is introduced into the diet, from about 6 months to adulthood. Symptoms include diarrhea, abdominal distention and discomfort, lactose intolerance, poor growth, vitamin deficiencies, and iron-deficiency anemia.
Frequent cause of chronic diarrhea in pediatric patients. Often associated with bloating and flatulence. Milk or milk products exacerbate the diarrhea. Congenital lactase deficiency is an autosomal-recessive disorder that presents in infancy and is extremely rare. Late-onset lactose intolerance is due to a progressive loss of enzyme activity in the brush border of the small bowel mucosa this can begin as early as 5 or 6 years of age in some ethnic groups. Acquired lactose intolerance occurs after any illness that causes damage to the small bowel mucosa.
Crohn's disease is an inflammation of the wall of the colon and may affect the entire intestinal tract. Colitis is closely related but involves only the colon. Inflammations evolve in cycles and go into remission. Symptoms include abdominal cramps, fatigue, weight loss, fever, and often bloody diarrhea. The cause for both is unknown but could be stress-related or an autoimmune disorder. Food allergies are another possibility. The illness has been successfully treated when allergens have been removed from the diet. The most common offenders are wheat, dairy, yeast, sugar, eggs, corn, and vegetables of the cruciferous family broccoli, brussel sprouts, cabbage, and cauliflower. Hista-mine that is released during an allergic response may not be broken down properly in affected individuals. Malabsorption can be a complication and a diagnosis should be made for any nutritional deficiencies. Smoking aggravates Crohn's disease. Avoid animal fats and omega-6 vegetable oils as they have an...