ALLERGOLOGY Removals Review By Alec Maquiling

OUTLINE I. Adverse Food Reactions II. Anaphylaxis III. Urticaria and Angioedema C4. Cross-reactivity: when an antibody reacts not only with the original allergen but also with a similar allergen -NOTE: LATEX cross reacts with banana, avocado, kiwi, and chestnuts C5. Correlation with other diseases - FA coexists with asthma, atopic dermatitis, eosinophilic esophagitis, and exercise-induced anaphylaxis -Coexistence of FA and ASTHMA is a risk factor for asthma exacerbations - Exercise-induced anaphylaxis: it happens when you eat a certain food (most common triggers: shellfish, alcohol, tomatoes, cheese, celery), then you exercise. The food triggers mentioned can be eaten WITHOUT symptoms in the absence of exercise. - 75% of patients who experience this are females! C6. Natural History of Food Allergy - Most FA will tolerate milk, egg, soy and wheat (but time course varies and may occur as late as teenage years) - A higher initial level of serum IgE against a certain food is associated with a lower rate of resolution C7. Types of Food Allergy (REMEMBER THIS) C7.1 IgE-MEDIATED FOOD ALLERGY C7.1.1 Clinical Features: -RAPID onset (within 1-2 hours) -Resolve quickly (within minutes to few hours) -Several symptoms involved: MOST COMMONLY INVOLVED: SKIN, 2nd most commonly involved: Gastrointestinal C7.1.2 Examples Allergy of IgE-Mediated Food

I. ADVERSE FOOD REACTIONS  Definition: ANY reaction following the ingestion of a food. A. ORAL FOOD TOLERANCE: suppression of adverse immune responses to nonharmful food antigens. A1. Mechanisms: 1. Mucosal Barrier (Intestinal Intraepithelial cells, secretory IgA, Regulatory T cells, Commensal Flora) 2. Balance of Th1 and Th2 cells B. FOOD INTOLERANCE: adverse WITHOUT a clear immune mechanism event

B1. HOST factors: enzyme deficiencies, GI disorders, idiosyncratic reaction, psychologic, migraines B2. FOOD factors: infectious organisms (S. aureus, E. coli, C. difficile), toxins (scombroid poisoning [histamine]), pharmacologic agents, contaminants C. FOOD ALLERGY (FA): a reaction WITH an immune mechanism C1. Prevalence - 2.5% of newborn infants have hypersensitivity to COW MILK in the FIRST year of life. -About 1.5% of young children are allergic to EGGS. C2. Common food allergens (in the Philippines) - Seafood, fish, eff, milk, soy, peanuts (Note: Chicken allergy is NOT common) - PEANUT allergy: most common cause of anaphylaxis in children leading to an ER consultation. - REMEMBER: PROTEIN component is responsible for causing food allergy C3. Genetics (chance of getting food allergy) - If both parents both have food allergy: 50-80% - If both parents are atopic: 40-60% - If one of the parents have food allergy: 40% - If neither parent has food allergy: 15%

1. Oral Allergy Syndrome -aka POLLEN-associated FA syndrome (because it also commonly affects those who are allergic to pollens) -allergy usually to RAW fruits and vegetables - confined to LIPS, MOUTH, THROAT 2. Acute Urticaria - rapid onset after ingestion of food characterized by round or irregular shaped PRURITIC WHEALS

Esophageal Gastroenteritis -pathologic infiltration of the GI tract by eosinophils 3. vitellin.LOCALIZED inflammation of the esophagus 2. lecithin. OVOVITELLIN. coagulant. OVALBUMIN. livetin. Management of Food Allergy . binder.Atopic March (Atopic Dermatitis then Asthma then Allergic Rhinitis) C8. ice cream. globulin. SAUSAGES. Food Protein-Induced Enterocolitis Syndrome .4 Mixed Conditions (both IgE and NonIgE-mediated) 1. OVAMUCIN.currently NO CURE exists . boullion. Eosinophilic Esophagitis . C7. cake flours. well-defined edematous swelling that involves subcutaneous. candy. .IgE-mediated Skin Prick Test: cannot be diagnostic BUT can be used to confirm ABSENCE of IgE-mediated reaction .mutation on the protein FILAGGRIN .1. . breakfast cereals. marshmallows. baking mixes. emulsifier.ALLERGOLOGY Removals Review By Alec Maquiling 3. lysozyme. diarrhea. they CANNOT be considered diagnostic of FA. powdered egg. NON-pruritic. young people. . cookies. Atopic Dermatitis . C7. Food Protein-Induced Allergic Proctocolitis -in “healthy” infants who have visible specks or streaks of blood with mucus in the stool -many infants present while being breast-fed 2.Double Blind Placebo Controlled Oral Food Challenge (Gold Standard) C9. most common cause are milk and soy protein -in adults.3 Examples of Non-IgE-Mediated Food Allergy 1. egg noodles. most often related crustacean shellfish barrier dysfunction . Moreover. failure to thrive . egg white.Although History and PE can aid in the diagnosis. whole egg) and food that may contain egg protein (baked goods.presents as chronic emesis. egg yolk. French toast. Angioedema -often occurs in combination with urticaria -NON-pitting. cocoa. parent and patient reports must be CONFIRMED because 50 to 90% of presumed FAs are not allergies. macaroni.standard of care: STRICT ALLERGEN AVOIDANCE -NOTE: VERY IMPORTANT to memorize Labels that Indicate Egg Protein (particularly ALBUMIN. Diagnosis of Food Allergy -FA should be considered in patients with anaphylaxis or any combination of symptoms that occur within minutes to hours of ingesting food. abdominal organs or upper airway.1.

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