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Integrative Nutrition and Pathophysiology > Food Allergy Module 1 > Flashcards

Food Allergy Module 1 Flashcards

1
Q

role of nutrition in disease = (3 Ps)

A

role of nutrition in disease = prevention + pathogenesis + prognosis

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2
Q

how to prevent allergies in childhood?

A

early exposure

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3
Q

role of nutrition in allergy: prevention

A

early introduction of allergenic foods to reduce development of food allergies, timing is critical!

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4
Q

role of nutrition in allergy: pathogenesis

A

immune response to food trigger

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5
Q

role of nutrition in allergy: prognosis

A

avoiding foods, allergy oral immunotherapy

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6
Q

3 treatment options for allergy

A
  1. Medical nutrition therapy (MNT): avoiding foods
  2. Treating severe reactions when they happen
  3. Allergy immunotherapy
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7
Q

nutritional issues that impact immunity

A
  1. alcohol
  2. weight
  3. poor diet
  4. chronic disease
  5. mental stress (cortisol)
  6. lack of sleep
  7. diet and lifestyle patterns
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8
Q

food hypersensitivity =

A

food hypersensitivity = adverse reaction to foods

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9
Q

is intolerance immune-mediated?

A

no

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10
Q

immune mediated wheat hypersenstivity

A
  1. allergy: wheat allergy
  2. autoimmunity: CD and dermatitis herpetiformis
  3. sensitivity (non-allergic/non-autoimmune): NCWS
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11
Q

non-immune mediated wheat hypersensitivty

A

intolerance: FODMAP intolerance

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12
Q

wheat allergy trigger

A

gluten and/or non-gluten proteins
GI tract, skin, respiratory

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13
Q

wheat allergy symptoms

A

same as other allergies
rapid onset

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14
Q

wheat allergy mechanism steps (6)

A
  1. Presentation of allergen to and activation of T cells
  2. T cell help to IgE-producing B cells
  3. Production of IgE by B cells in response to an allergen (in predisposed individual)
  4. Binding of IgE to mast cells (through Fc region), called sensitization
  5. Antigen re-encounter and cross-linking of bound IgE by re-introduced antigen
  6. Release of mast cell mediators (degranulation)
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15
Q

wheat allergy:
degranulation releases __, __, and other __ which cause __ including __ and __ of __, and __

A

wheat allergy:
degranulation releases histamine, proteases, and other inflammatory mediators which cause inflammation including dilation and leakiness of blood capillaries, and tissue damage

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16
Q

wheat allergy:
released cytokines recruit __ (__, __, and __) leading to symtpoms of __

A

wheat allergy:
released cytokines recruit leukocytes (neutrophils, eosinophils, and Th) leading to symtpoms of allergies

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17
Q

allergy symptoms

A
  1. sneezing
  2. nasal irritation
  3. itchiness
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18
Q

anaphylaxis is the most severe form of __ caused by widespread and sudden __ cell __ in response to an __

A

anaphylaxis is the most severe form of hypersensitivity caused by widespread and sudden mast cell degranulation in response to an antigen

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19
Q

anaphylaxis is associated with

A

dilation of blood vessels and sharp drop in blood pressure

20
Q

wheat allergy genetic marker

A

elevated levels of IgE antibody to gluten and non-gluten proteins
Commonly IgE to:
ω-gliadins
α-amylase/protease inhibitors (ATIs)

21
Q

wheat allergy testing

A

IgE antibody and skin prick tests

22
Q

wheat allergy treatment

A

wheat-free diet
anti-histamines
epinephrine

23
Q

some ppl with wheat allergy are cross reactive to

A

rye and barley

24
Q

celiac disease (CD) and dermatitis herpetiformis (DH) trigger

A

gluten in wheat and related cereals

25
Q

CD and DH target

A

small intestine in CD, skin in DH

26
Q

CD and DH symptoms

A

CD: diarrhea, pain, malnutrition
DH: skin rash

27
Q

CD genetic component

A

strong genetic component
linked to class II HLA genes (DQ2/DQ8)

28
Q

CD involes which 2 immune responses

A

innate and adaptive

29
Q

CD involves immune response to (3)

A
  1. Anti-gluten antibody
  2. Anti-deamidated gluten antibody
  3. Anti-transglutaminase 2 antibody
30
Q

CD testing: 3 options

A
  1. Blood tests: most sensitive and specific marker:
    IgA to tissue transglutaminase (tTG or TG2)/IgA anti-endomysial antibody
  2. IgG to deamidated gluten (“DGP”) useful in cases of IgA deficiency.
  3. Genetic testing (HLA-DQ2/8) useful in equivocal cases and children
    Useful in difficult cases, low positive predictive value bc a lot of people have this gene
    *Antibodies to native gluten (gliadin) no longer used in context of celiac disease.
31
Q

what type of testing is no longer used in CD

A

Antibodies to native gluten (gliadin) no longer used in context of celiac disease

32
Q

CD diagnostic algorithm

A
  1. suspicion of CD
  2. serologic tests (IgA anti-TG2)
  3. intestinal biopsy
  4. provisional diagnosis of CD
  5. GFD
  6. definitive diagnosis if GFD causes improvement
33
Q

CD treatment

A

lifelong GFD

34
Q

NCWS definition

A
  • Onset of symptoms in response to ingestion of wheat, rye, and barley
  • Resolution of symptoms on removal of those foods from diet
  • In patients in whom celiac disease and wheat allergy have been ruled out
35
Q

NCWS symptoms

A

intestinal: abdominal pain, diarrhea, bloating
extra-intestinal: fatigue, headache, cognitive difficulties

36
Q

speed of symptom response: WA, CD, NCWS

A

WA < NCWS < CD

37
Q

triggers of NCWS

A

wheat, gluten
fructans
ATIs

38
Q

NCWS as a subset of IBS

A

some ppl with IBS appear to have NCWS
wheat-free diet reduces IBS symptoms in patients with anti-gluten antibody

39
Q

is NCWS immune mediated

A

in substantial proportion

40
Q

3 types of markers of NCWS

A
  1. elevated response to wheat gluten (IgG2, IgG4, IgM)
  2. systemic innate immune activation in response to microbial translocation (LBP, sCD14)
  3. intestinal cell damage (FABP2)
41
Q

proposed mechanism for NCWS

A

data point to microbial translocation across intestinal barrier

42
Q

ATIs

A

α-amylase/protease inhibitors (ATIs or APIs) of wheat shown to be strong activators of innate immune response through the engagement of the TLR4-MD2-CD14 complex

43
Q

NCWS treatment

A

GFD

44
Q

potential downsides of GFD

A

Processed gluten-free products may contain ingredients inferior to their gluten-containing counterparts in nutritional value.
Avoiding wheat products may result in lower fiber intake (affecting cardiovascular risk).
Gluten-free breads and cereals less likely to be fortified.
Heavy metal concentrations higher in gluten-free foods (attributed to rice content) and in blood/urine of gluten-free people.
BUT:
Poorer health outcome not linked to gluten-free diet in vast majority

45
Q

GF food is usually but not always
wheat-free food is usually but not always

A

GF food is usually but not always wheat-free
wheat-free food is usually but not always GF

46
Q

FDA definition of gluten-free

A

A) The food is inherently gluten-free (e.g., corn, potato, etc.)
B) Does not contain an ingredient that is:
1) a gluten-containing grain (e.g., wheat, rye, barley, spelt, etc.)
2) derived from a gluten-containing grain but processed to remove gluten (e.g., wheat flour) to below a concentration of 20 ppm.
C) Any unavoidable presence of gluten in the food must be less than 20 ppm.

47
Q

how was FDA’s 20 ppm limit decided upon?

A

The FDA recommendation of 20 ppm for the “gluten-free label” was based on the fact that it was the lowest level to be reliably detected in foods using established analytical tools (consistent with the clinical recommendation).
It was NOT based on data suggesting 20 ppm as the safe level.

Integrative Nutrition and Pathophysiology (22 decks)

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