A food allergy manifests as an exaggerated immune response to food ingredients, usually on proteins. Manifestations are very different and can atopic dermatitis, gastrointestinal or respiratorischeSymptome and anaphylaxis include. The diagnosis is a history and sometimes due to allergen-specific serum IgE tests, skin tests and / or exclusion of inducing foods. Treatment consists of avoiding the foods that trigger the reaction, and sometimes oral vera brechtes cromolyn.
Food allergies should be distinguished from reactions that are not caused by the immune system (eg., Lactose intolerance, irritable bowel syndrome, infectious gastroenteritis) and of reactions to food additives (eg., Sodium glutamate, metabisulfite, tartrazine) or contaminated food (eg. B. latex dust in food, which is transmitted from people with latex gloves); the latter are responsible for most of these reactions. The prevalence of food allergy is with geographical variations and different calculation methods <1-3%; Patients tend to be confused with intolerance allergy.
A food allergy manifests as an exaggerated immune response to food ingredients, usually on proteins. Manifestations are very different and can atopic dermatitis, gastrointestinal or respiratorischeSymptome and anaphylaxis include. The diagnosis is a history and sometimes due to allergen-specific serum IgE tests, skin tests and / or exclusion of inducing foods. Treatment consists of avoiding the foods that trigger the reaction, and sometimes oral vera brechtes cromolyn. Food allergies should be distinguished from reactions that are not caused by the immune system (eg., Lactose intolerance, irritable bowel syndrome, infectious gastroenteritis) and of reactions to food additives (eg., Sodium glutamate, metabisulfite, tartrazine) or contaminated food (eg. B. latex dust in food, which is transmitted from people with latex gloves); the latter are responsible for most of these reactions. The prevalence of food allergy is with geographical variations and different calculation methods <1-3%; Patients tend to be confused with intolerance allergy. Etiology Almost any food or almost every additive can cause an allergic reaction, but the most common triggers are in infants and young children: are nuts and seafood cross-reactions between food and non-food related allergens: milk, soy, eggs, peanuts and wheat In older children and adults known. Sensitization device may not enterally. been, for example, patients with oral allergy (typically pruritus, erythema, and mouth edema after eating fruits and vegetables) may by exposure to pollen, which have the same antigens as the food itself, sensitized; in children with an allergy to peanuts may be sensitization to topically applied, peanut oil containing creams to treat skin rashes. Many patients who are sensitive to latex are also allergic to bananas, kiwis, avocados or a combination thereof. In general, food allergies of IgE or T-cells or mediated by both. The first manifestation of an IgE-mediated allergy is acute (eg. As urticaria, asthma, anaphylactic shock) and usually develops in childhood. Here people are affected with atopic diseases in the history of the most common. A T-cell-mediated allergy (. Eg gastroenteropathies by food proteins, celiac disease) manifest gradual and chronic; on häufgisten it occurs in infants and children. By IgE as well as T-cell-mediated allergies (z. B. atopic dermatitis, eosinophilic gastroenteropathy) tend to have a delayed onset or chronic. Eosinophilic Gastroenteropathie It is an uncommon disease that is characterized by pain, cramping, diarrhea with eosinophilia, eosinophilic infiltration in the gut and enteropathy with protein loss. Atopic diseases exist in prehistoric times. Sometimes the eosinophilic Gastroenteropathie is accompanied by an eosinophilic esophagitis and can dysphagia, dyspepsia without excess acid and motility disorders or trigger in children, feeding refusal and abdominal pain. Symptoms and signs The symptoms and complaints with food allergies vary depending on allergens, reaction mechanisms and patient age. The most common manifestation in infancy is the atopic dermatitis either alone or in combination with gastrointestinal symptoms (such as nausea, vomiting, diarrhea). These reactions regress normally, while children react increasingly sensitive to inhaled allergens and symptoms such as asthma and rhinitis begin to develop. This process is called atopic march. At the age of 10 years, a food in children can hardly provoke respiratory symptoms, although the skin tests remain positive. If an atopic dermatitis persists and occurs only in older children or adults, their activity of IgE-mediated allergy appears to be largely independent, even if atopic patients have developed dermatitis with higher IgE levels in serum as atopic dermatitis patients without. If a food allergy in older children and adults is, the reactions tend to be heavier (z. B. explosive urticaria, angioedema, even anaphylaxis). In some patients, foods solve (especially wheat and shrimp) anaphylactic reactions only made when they weigh physically shortly after eating; the mechanism is unknown. Foods can also cause non-specific symptoms (eg. As dizziness, syncope). Occasionally it may be related to food allergies to cheilitis, aphthous ulcers, Pylorospasm, spastic constipation, pruritus come in the anal region and perianal eczema. T-cell mediated responses relate primarily to the gastrointestinal tract, resulting in symptoms such as subacute or chronic abdominal pain, nausea, cramps and diarrhea. Tips and risks when patients have cryptogenic subacute or chronic abdominal pain, nausea, vomiting, cramps or diarrhea, food allergies should be considered. Diagnosis allergen-specific IgE tests Skin tests attempt an elimination diet (alone or by skin test or allergen-specific IgE tests) A severe food allergy is usually obvious in adults. If this is not the case or if there are children involved (the most common age group), a diagnosis can be difficult, and the state must be distinguished from functional gastrointestinal disorders. For the diagnosis of celiac disease Celiac disease: diagnosis. Tests (eg. As allergen-specific IgE tests, skin tests) and elimination diets are very useful in the diagnosis of IgE-mediated reactions. In case of suspected food-related reaction, the relationship between symptoms and food is examined by one of the following tests. Allergen-specific IgE tests Skin tests in both cases is not confirmed clinically relevant allergy by a positive test. Both tests can have false-positive or false-negative results. Skin tests are generally more sensitive than the allergen-specific serum IgE tests, however, tend also more likely to false-positive results. The skin test provides within 15 to 20 minutes a result, much faster than the allergen-specific serum IgE test. If any of the tests is positive, the allergenic foods must be removed from the menu; when the symptoms improve, (preferably in a double-blind experiment) it is determined whether the symptoms appear again by re-supply of the food. (See also the medical position paper of the National Institute of Allergy and Infectious Diseases (NIAID). Guidelines for the diagnosis and management of food allergy in the United States) alternatives to skin tests include one or both of the following: withdrawal of food from which the patient believed to cause symptoms prescribing a diet of relatively allergen-free foods (see table: Permissible foods in elimination diets *), which ordinary allergens are excluded in the latter diet no other food and beverages should be consumed as prescribed. and the purity of the products should always be respected. Many of the commercially prepared products and meals contain unwanted foods into often larger amounts (eg. As rye bread contains wheat flour) or in traces as flavor enhancers or thickeners. The determination of unwanted foods into commercial products can be difficult. If after the first week there is no improvement, another diet should be tried. However, the improvement in T cell-mediated responses may take weeks. If the symptoms improve, a new food is added, and> 24 h eaten in large amounts or until symptoms recur. Alternatively, smaller amounts of the test food can eaten in the presence of the doctor and the patient’s reactions are observed. Worsening or recurrence of symptoms after adding a new food is the best evidence for a corresponding allergy. Acceptable food in elimination diets * food diet no. 1 (no beef, pork, poultry, milk, rye or corn) diet no. 2 (no beef, lamb, milk or rice) diet no. 3 (no lamb, poultry, rye, rice, maize or milk) Grain Products Rice Products Corn Products No vegetables artichokes, beets, carrots, lettuce, spinach asparagus, corn, peas, squash, beans, tomatoes beets, lima beans, potatoes (white and sweet) , green beans, tomatoes lamb bacon, chicken fat, beef Flour (bread or biscuits) Rice Corn, 100% rye (usual rye bread contains wheat) lima beans, potato, soybean fruit grapefruit, lemons, pears apricots, peaches, pineapples, plums apricots, grapefruit, lemons, peaches fatty oil from cottonseed, olive oil corn -, cottonseed oil from cotton seeds, olive oil drinks Coffee (black), soft drinks, tea, coffee (black), soft drinks, tea, coffee (black), lemonade, juice of approved fruit, tea Other cane sugar, gelatin, maple syrup, olives, salt, tapioca pudding cane sugar, corn syrup, gelatin, salt cane sugar, gelatin, maple syrup, olives, salt, tapioca pudding * dietary no. 4: When the symptoms after the 3 above-mentioned elimination diets still exist and to be the suspected food allergy is, the daily diet may be restricted (with extensively hydrolyzed or amino acid-based formulas) to an elemental diet. Therapy elimination diet Sometimes orally administered cromolyn Sometimes corticosteroids in eosinophilic enteropathy Treatment of Lebensmittelalergien is to omit the food that triggers the allergic reaction. Diagnosis and treatment thus overlap. Sensitivities to food can also regress spontaneously. Oral desensitization (initially with the omission of the allergenic food for a certain time and then administration of small, daily increasing amounts) and the use of an immune treatment using a dropwise sublingual application of food extracts are currently being investigated. Cromolyn sodium in an oral formulation was apparently applied with success in reducing allergic reaction. Except in cases of acute generalized reactions such as urticaria and angioedema is the use of antihistamines of little value. A corticosteroid long-term therapy is indicated for symptomatic eosinophilic enteropathy. Patients with severe food allergies should be advised to take antihistamines with you, and they shall take immediately if a reaction starts and a prefilled syringe with epinephrine for self-injection, if severe reactions occur. Summary food allergy is often IgE-mediated (which typically has acute systemic allergic reactions result) or T-cell mediated (which usually means chronic gastrointestinal symptoms). Food allergies should be distinguished (eg., Sodium glutamate, metabisulfite, tartrazine) of reactions that are not caused by the immune system (eg., Lactose intolerance, irritable bowel syndrome, infectious gastroenteritis) and of reactions to food additives or contaminated food. If the diagnosis in adults is clinically inconclusive or children are examined, skin tests, an allergen-specific serum IgE test or an elimination diet can be applied. Make sure that patients understand the importance of an elimination diet: they can only eat foods that are on the list and only pure food (which includes many commercially prepared foods off). More information National Institute of Allergy and Infectious Diseases (NIAID): Guidelines for the diagnosis and management of food allergy in the United States