Development and Nutrition- Food Intolerances/Allergies- LER Lecture

Cross-Reactivity

Antibody reacts to original AND similar allergen.

Breastmilk Substitutes- Specialized

Elecare Pregestimil Neocate Tolerex

Food and Baby Reaction Diary

Mom keeps track of all food and drinks she consumes along with the times she consumes them. Mom keeps track of all symptoms that the baby shows, such as colic, stool color, or skin reaction. Non IgE mediated (delayed) reactions will not show correlation between consumption of an allergen and a direct reaction. May take 6-24 hours to notice a reaction. When the baby has a reaction, mom should review the last 24 hours and see if there was something different in her diet or if she binged on a particular food that is usually eaten in smaller amounts.

____, ____, and ____ account for the vast majority of IgE-mediated reactions in teenagers and adults

Peanuts; tree nuts; seafood

Sensitization

Presence of allergen-specific IgE without clinical symptoms

Signs, Symptoms, and Manifestations of Allergy (General)- Skin

Rash, atopic dermatitis (atopic eczema) Urticaria, rash, hives Severe diaper rash Excessive pallor Brilliant red cheeks

Respiratory/ENT Manifestations

Rhinitis Bronchitis Otitis media (especially recurrent) Coughing Stridor, wheezing Croup Asthma Conjunctivitis Allergic shiners

A rash can be caused by a skin irritation True or False

True. A rash can be caused by several things including an allergy, infection, or skin problem like eczema or psoriasis

The ingredients in processed foods are listed in order of what is most ______.

abundant

Food allergy

an adverse reaction to food caused by one or more immune hypersensitivity mechanisms and is not confined to IgE. The specific immune response occurs reproducibly on exposure to a given food.

What is the MOST common reaction you will see in your lactation practice to suspect food sensitivity

colic

Allergenic proteins are found in the egg ____.

white

Foods Most Commonly Associated With Allergic Reactions

#1 is Dairy followed by, in no particular.... Soy- children Wheat- children Peanuts, legumes- children & adults Tree nuts- children & adults Fish or shellfish- adults Corn- adults (vegetables) Citrus- adults (fruit)

Food Induced Anaphylaxis

A serious allergic reaction that is rapid in onset and may cause death. An immediate hypersensitivity involving the immunologic activity of IgE homocytotrophic antibody and release of chemical mediators

Breastmilk Substitutes- Hypoallergenic

Alimentum Nutramagin

____ is the MOST IMPORTANT immunoglobulin in human milk. Not only in concentration, but also in biologic activity. Of the IgA immunoglobulins, ____ is the most significant!

IgA; SIgA

Idealized strategy and mechanism- Strategy- Minimize non-specific enhancing factors

Mechanism- avoid smoke and exposure to viral illnesses

Idealized strategy and mechanism- Strategy- Prevent postnatal sensitization of food allergens transmitted through breastmilk

Mechanism- continue maternal dietary avoidance during lactation. Withhold all non-breastmilk foods for at least six months

____, ____, and ____ account for the vast majority of IgE-mediated reactions in young children

Milk; egg; peanut

Other Possible Symptoms of Allergies/Sensitivities

Reluctance of feed Anorexia Excessive crying Poor sleep patterns Excessive sleep Irritability Hyperactivity Drowsiness Migraine headaches Fever and high C-reactive protein level

Breastmilk Substitutes- Common

Whey based Casein based Soy based

Most common foods associated with allergy in infants/children

cow's milk, hen's egg, peanuts, tree nuts, soy bean, and wheat

Combination of _____ and _____ given perinatally to infants for 6 months reduced risk of _____, including food allergy before two years of age.

prebiotic; probiotic; allergy

When a mom is keeping a food diary, tell her to write down the first _____ from the food label.

5 ingredients

I cannot get a skin allergy from foods that I have eaten for a long time. True or False

False. Food allergy can develop later in life. It may present as skin rash, vomiting, tingling of the mouth, swelling of the tongue and throat, and hives, as well as more serious problems. Some of the most common food allergies found in older allergic persons are peanut, tree nuts, fish, and shellfish.

I cannot get a rash from jewelry that I have worn for a long time. True or False

False. This is called contact dermatitis, which is often due to nickel.

How to know which foods to eliminate first:

Family history Food and baby reaction diary

Food intolerance

a reproducible adverse reaction to the ingestion of a food which does not have established or likely immunologic mechanisms

Some foods cause food allergy more often than others in children. True or False

True. In children up to 90% of food allergy is caused by: milk, eggs, peanuts, wheat, soy, and tree nuts

A food allergy can cause a skin rash True or False

True. Symptoms of a food allergy can appear very soon after eating the food or up to two hours after, and it usually is not seen until after you have eaten the food before.

Symptoms of a food allergy may be present with more than just a skin rash. True or False

True. Symptoms of a food allergy can present with skin rash, vomiting, tingling of the mouth, swelling of the tongue and throat, and hives. More serious problems might include difficulty breathing and a drop in blood pressure which can lead to severe reactions called anaphylaxis and can result in death if not treated rapidly.

There are several common household substances that can cause skin dermatitis. True or False

True. This is called irritant contact dermatitis which is more common than allergic contact dermatitis. This form can account for about 80% of contact dermatitis. Some of these common household substances include: strong soaps, detergents, drain cleaners, acids, acetone, and plants. These rashes might resemble a burn with red, chapped, and dry skin. This rash might be more painful than itchy.

The common rash of people with allergies is called atopic dermatitis. True or False

True. This is the common rash of people with allergies- it is called atopic dermatitis a type of eczema that can be a chronic skin problem that causes dry skin, intense itching, and maybe a red, raised rash.

The most common symptoms associated with food-induced allergic disorders in the exclusively breastfed infant

cutaneous reactions such as erythemi

NIAID suggests that parents should consider using hydrozalized infant formulas instead of cow's milk formulas to prevent.....

food allergy from developing in children at risk for food allergy and who are not exclusively breastfed.

The ______ is the body's largest immune organ containing approximately ____ of ALL the immunoglobulin-producing cells

gut; 80%

In cases of fatal food-induced anaphylaxis, ____ are generally the most common culprit.

peanut allergic reactions

Most common foods associated with allergy in adults

peanuts, tree nuts, fish, crustaceans, mollusks, fruits, and vegetables

About _____ of children with IgE-mediated cow's milk protein allergy also react to beef.

13-20%

Cow's milk allergy affects about ____ of infants. Tolerance is often achieved (about 85%) by _____.

2.5%; 3-5 years

Egg allergy affects about ____ of infants. Tolerance is usually achieved by the age of _____.

2.5%; 5 years

Research has shown a ______ chance of a cross-over reaction with ____ and soy.

30-50%; dairy

GI Manifestations of Allergies

Abdominal pain Colic Vomiting GE reflux Diarrhea Malabsorption Blood streaked stools Green or frothy stools Chronic diarrhea Constipation Colitis Bad breath Drooling Itching, burning mouth Swelling lips, tongue, gums, pharynx

IgE Mediated Reaction (Immediate Reaction)

Antigen sensitizes T-cells Helper T-cells activate B cells The B cells then secrete allergen-specific IgE IgE circulates, attached to mast cells, throughout the body Antigen binds to IgE in mast cells Mast cells release histamine Typically involve small amounts of food Re-occurs each time the food is eaten Symptoms appear within a short period of time Obvious allergen Symptoms may be as severe as anaphylaxis 5% of cases Diagnosed by history

IgG Mediated Reaction (Delayed or Cyclic Reaction)

Antigens sensitize T-cells to the antigen When the T-cells are re-exposed to the antigen and they release mediators that activate cytotoxic cells and macrophages Usually involves large, repetitive amounts of food Clears with food avoidance Difficult to identify 95% of cases Detection based on history and food challenge Small amounts of offending food can relieve symptoms temporarily Food elimination for 5-6 months

50-90% of reported allergies are NOT _____. True food allergy must be explained to parents in order to help them understand the difference between allergy and sensitivity.

IgE mediated allergies.

Idealized strategy and mechanism- Strategy- Identify at-risk families

Mechanism- document IgE reactivity in parents with history of allergic disorders or existing child with allergies

Idealized strategy and mechanism- Strategy- Reduce environmental allergens

Mechanism- instruct parents in avoidance of animals, mite, and mold allergens. Avoid unnecessary medications.

Idealized strategy and mechanism- Strategy- Prevent intrauterine sensitization

Mechanism- reduce maternal dietary allergic load during the last trimester

Idealized strategy and mechanism- Strategy- Maximize immunologic competence

Mechanism- support exclusive breastfeeding for at least 6 months

Can a breastfed baby be allergic to his own mother's milk? Yes or No

No! Babies can be sensitive to something that the mother eats that passes into breastmilk, but not to the breastmilk itself.

Can a breastfed baby be lactose intolerant? Yes or No

No. Babies cannot be lactose intolerant unless they have a serious metabolic disorder

Various tests that may be performed to identify food allergen

Skin prick/puncture test Intradermal testing Allergen-specific IgE in the serum Combination of skin prick/puncture test, sIgE test and atopy patch test Food elimination diet Oral food challenge

True Food Allergy Symptoms in Infants/Children

Skin: atopic eczema, urticaria Skin & Mucosa: angioedema Respiratory tract: laryngoedema, bronchial obstruction (possibly with wheezing) Systemic: anaphylaxis Gastrointestinal: proctitis, perianal eczema General Symptoms: nausea, vomiting, diarrhea, constipation

_____ formulas are not an appropriate substitute for cow's milk based formulas because of the chance of _____.

Soy; cross-sensitivity

Food Allergen

Specific components of food or ingredients in food (typically proteins) that are recognized by allergen-specific immune cells eliciting an immune reaction resulting in characteristic symptoms

The infant's immature gut plays an important role in food sensitization because:

There is decreased IgA in the saliva and gut Mucosal lining of the gut is more permeable

Can I get a skin allergy to medications that I have had before? Yes or No

Yes. Medication allergies usually develop after you have had the medication the first time. Some common medications that can cause skin allergy include penicillin, sulfa drugs, barbiturates, and anticonvulsants just to mention a few. Some of the symptoms from drug allergies might be hives, skin rash, itchy skin or eyes, congestion, and swelling of the mouth and throat.

Can I get tested for food or medication allergy? Yes or No

Yes. Your local allergist can do a skin prick test or blood test to find out if you are allergic to several foods and drugs.

A ______ barrier minimizes the passage of potential antigens into the mucosa and into circulation

healthy mature gut

According to the NIAID only a _______ can diagnose a food allergen and food allergy

oral food challenge