Podcast
Questions and Answers
What characterizes delayed hypersensitivity reactions in allergic disorders?
What characterizes delayed hypersensitivity reactions in allergic disorders?
Which of the following is a common symptom associated with food allergies?
Which of the following is a common symptom associated with food allergies?
What is the most critical initial intervention in managing anaphylaxis?
What is the most critical initial intervention in managing anaphylaxis?
Which condition is classified as a non-IgE mediated food allergy?
Which condition is classified as a non-IgE mediated food allergy?
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What is the primary purpose of skin prick testing in the evaluation of food allergies?
What is the primary purpose of skin prick testing in the evaluation of food allergies?
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Which symptom is NOT typically associated with IGE mediated food reactions?
Which symptom is NOT typically associated with IGE mediated food reactions?
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What is the maximum time frame in which symptoms of an IGE mediated food reaction typically occur after exposure?
What is the maximum time frame in which symptoms of an IGE mediated food reaction typically occur after exposure?
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In managing anaphylaxis, which of the following is considered immediately necessary?
In managing anaphylaxis, which of the following is considered immediately necessary?
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Which of the following auto-injectors is suitable for patients over 25 kg?
Which of the following auto-injectors is suitable for patients over 25 kg?
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Which symptom is typically NOT part of gastrointestinal reactions in food allergies?
Which symptom is typically NOT part of gastrointestinal reactions in food allergies?
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What is the first step in the management of a patient experiencing anaphylaxis?
What is the first step in the management of a patient experiencing anaphylaxis?
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What percentage of patients presenting to the emergency room have an identifiable trigger for their symptoms?
What percentage of patients presenting to the emergency room have an identifiable trigger for their symptoms?
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Which of these symptoms is classified as a cardiovascular symptom of IGE mediated food reactions?
Which of these symptoms is classified as a cardiovascular symptom of IGE mediated food reactions?
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Which of the following symptoms would likely indicate a severe allergic reaction requiring immediate intervention?
Which of the following symptoms would likely indicate a severe allergic reaction requiring immediate intervention?
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What type of allergies are NOT mediated by IGE?
What type of allergies are NOT mediated by IGE?
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What distinguishes non IgE mediated food allergies from IgE mediated ones in terms of timing and symptoms?
What distinguishes non IgE mediated food allergies from IgE mediated ones in terms of timing and symptoms?
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Which method is NOT helpful in diagnosing food protein induced proctitis?
Which method is NOT helpful in diagnosing food protein induced proctitis?
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When managing anaphylaxis, which is considered a critical component of treatment?
When managing anaphylaxis, which is considered a critical component of treatment?
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What primary symptom differentiates lactose intolerance from food allergies?
What primary symptom differentiates lactose intolerance from food allergies?
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Which factor would indicate that skin prick testing is appropriate for assessing a patient’s food allergy?
Which factor would indicate that skin prick testing is appropriate for assessing a patient’s food allergy?
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In the context of food protein induced enterocolitis syndrome, which food is MOST LIKELY to cause symptoms in infants?
In the context of food protein induced enterocolitis syndrome, which food is MOST LIKELY to cause symptoms in infants?
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What type of food allergic reaction typically involves a T cell mediated response?
What type of food allergic reaction typically involves a T cell mediated response?
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Study Notes
Allergic Disorders Overview
- Twenty percent of the general population has an allergic disorder
- Family history is a strong predictor of allergies
- 30-50% of individuals have an allergic disorder if one first-degree relative has an allergic disorder
- 75% of individuals have an allergic disorder if two first-degree relatives have an allergic disorder
- Allergic disorders such as atopic dermatitis, asthma, allergic rhinitis, and food allergies often co-exist.
Objectives
- Identifying mechanisms of allergic reactions (immediate and delayed hypersensitivity)
- Differentiating food allergy from food intolerance
- Recognizing the signs, symptoms, and management of anaphylaxis
- Describing the pathophysiology of anaphylaxis
- Identifying signs and symptoms of food allergies
- Listing investigations for IgE-mediated and non-IgE-mediated food allergies
- Discussing long-term management of food allergies
Adverse Food Reactions
- Adverse reactions can be non-immune mediated (metabolic, pharmacologic, toxic) or immune mediated (IgE, non-IgE, mixed)
- IgE-mediated reactions are immediate hypersensitivity reactions
- Non-IgE-mediated reactions are delayed hypersensitivity reactions
- Examples of immune-mediated reactions: anaphylaxis, food protein-induced enterocolitis syndrome, eosinophilic esophagitis
Allergic Reaction Mechanism
- Allergen (antigen) triggers the production of IgE antibodies by B-cells
- Subsequent allergen exposure causes IgE binding to mast cells or basophils
- The binding triggers degranulation and release of histamine
- Histamine increases blood capillary permeability and distension
IgE-Mediated Food Reactions
- 6-8% of children and 3-4% of adults experience food allergies
- Detailed history is crucial (food suspected, exposure details, specific symptoms, timing, reproducibility)
- Top nine food allergens include soy, eggs, peanuts, fish, sesame, shellfish, tree nuts, milk, and wheat
- Exposure details include previous exposure or route of exposure (ingestion, contact, inhalation).
IgE-Mediated Food Reactions: Symptoms
- Cutaneous: urticaria, angioedema
- Respiratory: rhinorrhea, cough, wheeze, shortness of breath.
- Gastrointestinal: nausea, abdominal pain, vomiting, diarrhea
- Cardiovascular: fainting, hypotension
IgE-Mediated Food Reactions: Timing and Reproducibility
- Reactions typically begin within minutes to two hours of exposure
- Reactions resolve within a few hours
- Reactions are reproducible with subsequent exposures to the same food
Case Study #1 (Infant)
- Symptoms: diffuse urticaria, wheeze, stable vitals
- Trigger: cow's milk protein 15 minutes prior
- Diagnosis: anaphylaxis
- Management: discontinue cow's milk protein, epinephrine, intravenous fluids
Case Study #2 (Infant)
- Symptoms: profuse vomiting, lethargy
- Trigger: oats (3 spoonfuls)
- Diagnosis: oat-induced enterocolitis syndrome
- Management: remove oats from diet
Case Study #3 (Adolescent)
- Symptoms: diarrhea, cramping, bloating (30 minutes after eating)
- Trigger: cow's milk protein foods (tolerates smaller amounts)
- Diagnosis: suspected cow's milk protein allergy.
- Management: determine cause
Non-IgE Mediated Food Allergies
- Immunologic reaction likely T-cell mediated
- Symptoms typically limited to the gastrointestinal tract (proctitis, enterocolitis)
- Examples of non-IgE-mediated responses include food protein-induced enterocolitis syndrome, and food protein-induced proctitis
Food Protein-Induced Proctitis
- Exclusively breastfed infants (2-8 weeks old)
- Transfer of the mother's ingested foods through breast milk
- Signs include cow's milk protein, egg, soy, corn.
- Presentation: blood-tinged stools (otherwise healthy symptoms).
- Skin testing and serum-specific IgE are often unhelpful
Food Protein-Induced Enterocolitis Syndrome
- Onset 1–4 weeks after introduction of food
- Foods implicated: cow's milk protein, soy, grains, rice, meat/poultry, egg, potato, legumes
- Symptom: repetitive vomiting (1–3 hours after ingestion)
- Skin testing and serum-specific IgE are often unhelpful.
Lactose Intolerance
- Non-immune mediated food reaction
- Caused by low levels of lactase enzyme in the small intestine, causing lactose to ferment, causing abdominal pain, bloating and diarrhea
- Treatment: lactose-free products.
Skin Prick Testing
- Solutions containing proteins (food, aeroallergens, venom, medications) are placed on the skin
- If the patient is sensitized, a localized hive develops.
Serum Specific IgE
- Laboratory test detecting the presence and quantifying allergen-specific IgE to identify allergic reactions
Allergy Referral
- Patient history is the primary tool for allergic disorders.
Management
- Discontinue the allergen
- Epinephrine auto-injector
- Intravenous fluids
- Antihistamines (for hives only)
- Anaphylaxis action plan
- Medical identification devices
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Description
This quiz provides an overview of allergic disorders, including their prevalence in the population and risk factors related to family history. It covers various allergies, identification of allergic reactions, and management strategies for conditions like food allergies and anaphylaxis.
