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Food Allergy Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital  Sharjah ,UAE [email_address]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Jason W.C. the Harriet lane Handbook.8 th  ed.p:388.Mosby.2009
 
   Nature of symptoms with immune  ( allergy )  and non - immune hypersensitivity reactions  ( intolerance)
 
Manifestations Often a combination of several syndromes 1.Anaphylaxis 2.Skin syndromes 3.Gastroentistinal syndromes 4.Respiratory syndromes
1.Anaphylaxis ,[object Object],[object Object],[object Object],[object Object],Uniphasic , Biphasic, or Protracted patterns
2.Skin Syndromes A.  Urticaria / Angioedema :   1.Chronic Urticaria rarely related to food allergy 2.Acute urticaria predicts risk for future anaphylaxis
Cont. ,[object Object],1. Food allergy more common in patients with atopic dermatitis 2. Acute and chronic skin changes often coexist
 
3.Gastrointestinal Syndromes ,[object Object],1-  Edema of  oral mucosa  after ingestion of certain fresh fruits and vegetables in patients with pollen allergies 2 - Inciting antigens destroyed by cooking 3 -   Caused by cross-reactivity of antibodies to pollens 4 -  Rarely progresses beyond the mouth
Cont. ,[object Object],1- Reflux ,abdominal pain ,diarrhea ,early satiety 2 – characterized by eosinophilic infiltration of  digestive tract
Cont. ,[object Object],1- Presents in infancy 2 – vomiting and diarrhea (may contain blood ) when severe may  lead to : Lethargy ,Dehydration ,Hypotension ,Acidosis 3 – Most commonly associated with  milk ,soy
Cont. ,[object Object],1- Confined to distal colon and presents with only diarrhea 2 – Symptoms of short duration ,rarely  leads to anemia
4.Respiratory syndromes ,[object Object],A. Rhinitis B. Asthma
Heiner syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Precipitating IgG antibody to cow’s milk
Diagnosis Food allergy is  suspected  when typical symptoms  occur with the introduction of specific foods. 2.Pharmacologic activity of foods Other  non-allergic mechanisms  of food intolerance should be ruled out: 1.Compromised digestive or absorptive processes 3.Contamination with microbes or toxins
Cont. ,[object Object],[object Object]
Cont. ,[object Object],[object Object]
Cont. ,[object Object],[object Object]
Cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cont. ,[object Object],[object Object]
Cont. ,[object Object],Among infants and children with food allergy ,  90%  of reactions are to  egg ,  milk ,  peanuts ,  soy , and  wheat
Cont. ,[object Object],[object Object]
Treatment and Prognosis.  The only therapy  proved effective for food allergy is  an elimination diet . Most  gastrointestinal manifestations  resolve within several days ,  although some may take weeks (food-induced enteropathy ).
Cont.  ,[object Object],At least  30%  of infants with  cow's milk allergy  also demonstrate  sensitivity to soy protein.
Cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cont. About  50%  of infants who  experience proctocolitis  while nursing  improve with removal of cow's milk  from the mother's diet. If the symptoms are  severe enough (anemia and hypoproteinemia)  decide to   change in the infant's diet to   a  protein hydrolysate formula.
Cont. ,[object Object],Resolution of symptoms from cow's milk or soy protein hypersensitivity   is   common by 1 yr of age .
Cont. When milk is reintroduced, only a teaspoon or less should be offered at first and then increased progressively over a few days if tolerated Even   older children and adults may   lose their sensitivity   to an   offending food when it is eliminated from the diet for 1 to 2 yr
Cont. ,[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you

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Food hypersensitivity

  • 1. Food Allergy Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE [email_address]
  • 2.
  • 3.  
  • 4.   Nature of symptoms with immune ( allergy ) and non - immune hypersensitivity reactions ( intolerance)
  • 5.  
  • 6. Manifestations Often a combination of several syndromes 1.Anaphylaxis 2.Skin syndromes 3.Gastroentistinal syndromes 4.Respiratory syndromes
  • 7.
  • 8. 2.Skin Syndromes A. Urticaria / Angioedema : 1.Chronic Urticaria rarely related to food allergy 2.Acute urticaria predicts risk for future anaphylaxis
  • 9.
  • 10.  
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Diagnosis Food allergy is suspected when typical symptoms occur with the introduction of specific foods. 2.Pharmacologic activity of foods Other non-allergic mechanisms of food intolerance should be ruled out: 1.Compromised digestive or absorptive processes 3.Contamination with microbes or toxins
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. Treatment and Prognosis. The only therapy proved effective for food allergy is an elimination diet . Most gastrointestinal manifestations resolve within several days , although some may take weeks (food-induced enteropathy ).
  • 27.
  • 28.
  • 29. Cont. About 50% of infants who experience proctocolitis while nursing improve with removal of cow's milk from the mother's diet. If the symptoms are severe enough (anemia and hypoproteinemia) decide to change in the infant's diet to a protein hydrolysate formula.
  • 30.
  • 31. Cont. When milk is reintroduced, only a teaspoon or less should be offered at first and then increased progressively over a few days if tolerated Even older children and adults may lose their sensitivity to an offending food when it is eliminated from the diet for 1 to 2 yr
  • 32.
  • 33.