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Block 3; Week 8 > Pediatric Food Allergies > Flashcards

Pediatric Food Allergies Flashcards

1
Q

What is the difference b/w a food allergy & a food intolerance?

A

Food Allergy–>immunologically mediated

Food Intolerance–>non-immunologically mediated

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2
Q

T/F People often get the hives for no reason at all.

A

True. Then they associate whatever they were eating with their reaction.

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3
Q

What are the subcategories of food allergies?

A

All immunologically mediated

  • *some disorders mediated by IgE (this is the immunoglobulin that creates hay fever)
  • *some disorders mediated by IgG, sensitized lymphocytes, or other mechanisms.
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4
Q

What category of adverse food rxns does lactose intolerance fall into?

A

Food intolerance b/c non-immunologically mediated.
Lack of lactase enzyme.
Won’t die from drinking milk–>but very unpleasant.

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5
Q

What is a food that you can get hives from–>that you aren’t necessarily allergic to?

A

Strawberries! there are bunches of histamine in this…can get hives if you have a ton.

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6
Q

What are the 4 main categories of non-immune adverse food reactions?

A 
Food Intolerance: 
Metabolic
Pharmacologic
Toxic
Other
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7
Q

What are 5 examples of metabolic food intolerance?

A
  1. Lactase Deficiency
  2. Fructose Intolerance
  3. Galactosemia
  4. Pancreatic Insufficiency
  5. Gallbladder/liver disease
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8
Q

What are 4 examples of pharmacologic food intolerance?

A
  1. histamine
  2. tyramine
  3. caffeine
  4. theobromine
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9
Q

What are 3 examples of toxic food intolerance?

A
  1. food poisoning
  2. scombroid fish poisoning
  3. ciguaterra fish poisoning
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10
Q

What are other things that fall into the category of food intolerance?

A

panic, anxiety
hiatal hernia
reflux

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11
Q

What basic type of food are people usu allergic to?

A

a specific protein in a food, usu not lipids

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12
Q

What is the usu profile of a food allergen?

A

water-soluble glycoprotein
heat & proteolysis resistant
molecular weight: 10-70kd

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13
Q

What are the most common food allergens?

A 
peanut: Ara h1, Ara h2, Ara h3
chicken egg white: Gal d1, Gal d2, Gal d3
soybean: gly m-1
fish: gad c1
shrimp: pen a1
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14
Q

What percentage of households report that at least one member of their family has a food allergy? What percentage of infants have a food allergy? What percentage of adults have a food allergy?

A

25-30% of households
6% of infants
3.7% of adults

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15
Q

What is the prevalence of this allergy in children?

cow milk

A

2.5%

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16
Q

What is the prevalence of this allergy in children?

eggs

A

1.3%

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17
Q

What is the prevalence of this allergy in children?

peanuts

A

0.8%

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18
Q

What is the prevalence of this allergy in children?

wheat

A

0.4%

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19
Q

What is the prevalence of this allergy in children?

soy

A

0.4%

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20
Q

What are some common allergic diseases of children?

A

eczema
food allergy
asthma
rhinitis

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21
Q

Which age population usu has allergies?

A

Children! A disease of children. Usu don’t develop allergies when you are an adult. A lot of food allergies decrease as you age.

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22
Q

We are talking about adverse reactions to food.

What is an IgE mediated mechanism that is systemic?

A

anaphylaxis

food-associated exercise-induced anaphylaxis

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23
Q

We are talking about adverse reactions to food.

What is an IgE mediated mechanism that is related to the skin?

A

urticaria

angioedema

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24
Q

We are talking about adverse reactions to food.

What is an IgE mediated mechanism that is related to GI?

A

immediate GI symptoms

Pollen food allergy syndrome

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25
Q

We are talking about adverse reactions to food.

What is an IgE mediated mechanism that is related to the respiratory system?

A

bronchospasms

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26
Q

What is urticaria?

A

hives

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27
Q

What is angioedema?

A

swelling

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28
Q

What is atopic dermatitis?

A

eczema

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29
Q

If you have eczema, does that mean that you have a food allergy?

A

50% of the time–yes!

50% of the time–no!

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30
Q

What type of food allergy is gluten in Celiac patients?

A

Food allergy

non-IgE mediated mechanism

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31
Q

We are talking about adverse reactions to food.

What is a non-IgE mediated mechanism that relates to the skin?

A

dermatitis herpetiformis

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32
Q

We are talking about adverse reactions to food.

What is a non-IgE mediated mechanism that relates to the GI system?

A

Celiac disease
enteropathy
Food-induced enterocolitis syndrome
allergic proctocolitis

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33
Q

We are talking about adverse reactions to food.

What is a non-IgE mediated mechanism that relates to the respiratory system?

A

Heiner’s syndrome

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34
Q

We are talking about adverse reactions to food.
Mixed b/w IgE & non-IgE mechanisms
What is something that relates to the skin?

A

atopic dermatitis

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35
Q

We are talking about adverse reactions to food.
Mixed b/w IgE & non-IgE mechanisms
What is something that relates to the GI system?

A

eosinophilic esophagitis

gastroenteritis

36
Q

We are talking about adverse reactions to food.
Mixed b/w IgE & non-IgE mechanisms
What is something that relates to the respiratory system?

A

asthma

37
Q

What is the most common mechanism of food hypersensitivity?

A

IgE mediated

38
Q

How does an IgE mediated allergic reaction work?

A

IgE antibodies produced for a specific epitope of the food allergen
these IgE antibodies bind to high affinity IgE receptors on basophils & mast cells
when exposed to the allergen a second time, 2 adjacent IgE antibodies bind together
receptor cross-linking occurs
a bunch of factors are released
body reacts

39
Q

Where are the high affinity IgE receptors found that are a part of the IgE-mediated mechanism?

A

on basophils & mast cells

in skin, GI tract, & resp tract

40
Q

What substances are released after receptor cross linking of 2 IgE antibodies?

A 
histamine
prostaglandins
leukotrienes
chemotactic factors
cytokines
41
Q

What are the end reactions that the body experiences w/ an IgE mediated allergic rxn?

A

vasodilation
smooth muscle contraction
mucus secretion

42
Q

Which cell is in charge of making IgE? Which specific cell is recruited to make it?

A

Th2 cells are responsible for making it.

B lymphocytes in particular make it.

43
Q

Of the patients who come to the emergency room with anaphylaxis…what percentage of them had a food allergy?

A

1/3

44
Q

How fast does an IgE mechanism work?

A

usually within an hour of ingestion

45
Q

What symptoms are caused w/ an IgE reaction?

A 
urticaria
angioedema
dyspnea
wheezing
hypotension
oropharyngeal pruritis
stridor
dysphoma
cough
nausea
vomiting
diarrhea
flushing
"sense of impending doom"
46
Q

What about an IgE reaction can result in fatalities?

A

severe laryngeal edema
irreversible bronchospasm
refractory hypotension

47
Q

What are the most common causes of anaphylactic reactions?

A

peanuts, tree nuts, shellfish

48
Q

What are risk factors for an anaphylactic reaction becoming fatal?

A

not recognizing that it is beginning
not getting immediate care
previous episodes of anaphylaxis
poorly controlled asthma

49
Q

Can diphenydramine or Benadryl save someone from anaphylaxis?

A

NO.

Only epinephrine shots.

50
Q

What is another name for the pollen food allergy syndrome?

A

oral allergy syndrome

51
Q

What are the symptoms of the pollen food allergy syndrome?

A

itching/tingling lips, tongue, palate, or throat
edema of the lips, tongue, uvula
tightness in the throat

52
Q

If you have a severe rxn w/ pollen food allergy syndrome–>what happens?

A

systemic reaction–>laryngeal edema, hypotension

53
Q

What is the basic explanation for pollen food allergy syndrome?

A

cross-reactivity b/w certain pollens & food allergens

54
Q

Most adults who claim to have food allergies have what?

A

pollen food allergy syndrome

55
Q

Which foods are cross-reactive for people who are sensitive to ragweed pollen?

A

bananas
pumpkins
melons

56
Q

Which foods are cross-reactive for people who are sensitive to birch pollen?

A 
raw carrots
celery
potato
apple
hazelnut
peach
kiwi
57
Q

Which foods are cross-reactive for people who are sensitive to alder pollen?

A

almonds
apples
strawberries

58
Q

Which foods are cross-reactive for people who are sensitive to grass pollen?

A

figs
melons
tomatoes
oranges

59
Q

What are the main ways to test for food allergies? Which one is the gold standard?

A

Skin tests
RAST tests
Patch tests
Food Challenges: gold standard, double blinded

60
Q

Describe allergy prick testing.

A

this tests immediate hypersensitivity to IgE mediated things, like fresh fruits & vegetables allergies
you read the test 20 minutes after you prick the skin.

61
Q

What are the advantages to allergy prick testing? What are the disadvantages?

A

Advantages: cheap, convenient, inexpensive
Disadvantages: limited to IgE mediated hypersensitivity & has a false positive rate > 50%
**why it is important to not use to test 100 different things
**if you have taken any antihistamines–>the test is worthless

62
Q

Would an allergy prick test work to test someone for Celiac disease?

A

No. it is NOT IgE-mediated

63
Q

Describe RAST testing.

A

This is also used for IgE-mediated allergies. It is a blood test that checks for serum levels of IgE against certain foods.

64
Q

What are the advantages & disadvantages of RAST testing?

A

Advantages: histamines don’t compromise the result
Disadvantages: false positive rate even higher! 70%

65
Q

Would it work to test for an IgG mediated mechanism with a RAST test?

A

NO!

66
Q

Can food allergies cause behavioral problems?

A

NO

67
Q

Describe allergy patch testing.

A
  • patches are put on the skin w/ nickel or some food particles
  • no bathing allowed
  • it can be read at 48-72 hours
  • tests delayed hypersensitivity sometimes via sensitized lymphocytes
  • *can sometimes be used for non-IgE mediated food allergies
68
Q

What are some conditions that allergy patch testing can help identify?

A

food protein induced enterocolitis syndrome

eosinophilic esophagitis

69
Q

What are some of the weaknesses of allergy patch testing?

A

false positive rates & false negative rates

messy preparation

70
Q

What are food challenges?

A

double-blinded placebo-controlled
used when diagnosis must be confirmed
observed incremental changes in the amount of the food in question.
epinephrine w/ crash cart must be available.

71
Q

What is FPIES?

A

food protein induced enterocolitis syndrome

severe, cell-mediated GI food hypersensitivity

72
Q

What are the symptoms of FPIES? What usu provokes this condition?

A

usu provoked by cow’s milk or soy

delayed onset of vomiting, diarrhea, & lethargy/dehydration

73
Q

Do the symptoms of the severe condition of FPIES include rash, wheezing, & swelling?

A

NO.

74
Q

Aside from cow’s milk & soy, what other foods can prompt the symptoms of FPIES?

A

grains (rice, oats, barley)
vegetables (sweet potato, squash, string beans, peas)
poultry (chicken, turkey)

75
Q

Describe the usual level of severity of FPIES.

A

79% severe
57% sepsis resulted
64% hospitalized for dehydration or shock

76
Q

What is eosinophilic esophagitis?

A

an issue where you can easily get strictures in your esophagus, have trouble eating/swallowing
similar to asthma
eosinophilic
responds to steroids
chronic condition
strongly associated w/ allergies (food, pollens)

77
Q

T/F Asthma is an eosinophilic disease.

A

True.

78
Q

Why is eosinophilic esophagitis called by this name?

A

b/c if you take a biopsy of the strictured esophagus–>you will find a bunch of eosinophils.

79
Q

A lot of people with eosinophilic esophagitis also have some other conditions. Which conditions?

A

asthma
pollen allergy
hay fever
eczema

80
Q

Younger patients w/ eosinophilic esophagitis show more sensitization w/ what? Older adults–>show more sensitization w/ what?

A

Younger: IgE & patch sensitization
Adults: inhalant allergens

81
Q

What is the appropriate treatment for food allergies?

A

complete avoidance of the food

keep an epinephrine injector with them

82
Q

What is the treatment for eosinophilic esophagitis?

A

practice an elemental diet
systemic corticosteroids (like prednisone)
topical corticosteroids
allergy shots

83
Q

What are 2 kinds of topical corticosteroids?

A

swallowed MDI fluticasone

budesonide slurry

84
Q

If FPIES IgE-mediated?

A

No.

85
Q

Do epinephrine injections require training?

A

Yes.

Block 3; Week 8 (8 decks)

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