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## Adverse Food Reactions Allergies and intolerances are both types of adverse food reactions. Allergies are an immune response whereas intolerances are not. * Allergies may be almost instantaneous upon ingestion or contact with a food, or delayed reactions, which may occur hours later. * **Mi...

## Adverse Food Reactions Allergies and intolerances are both types of adverse food reactions. Allergies are an immune response whereas intolerances are not. * Allergies may be almost instantaneous upon ingestion or contact with a food, or delayed reactions, which may occur hours later. * **Mild reactions** may begin with localized swelling or itching. * **Stronger reactions** may result in generalized erythema and edema, increasing to mild wheezing and laryngeal edema. * **Severe anaphylactic reactions** result in hypotension, severe dyspnea, and cardiac and respiratory arrest. * The foods implicated in 90% of food allergies are cow's milk, peanuts, tree nuts, eggs, soya, wheat, fish, and shellfish. * **Intolerance** is the inability of the body to metabolize foods or food products, a nonimmunologic response. * Common intolerances are those related to enzyme deficiencies, such as lactose intolerance, or the inability to metabolize various other biochemicals, such as food additives. * Some intolerance is related to gastrointestinal abnormalities, such as cystic fibrosis, and others to psychological problems. ## Anaphylaxis Syndrome Anaphylaxis syndrome is a sudden acute systemic immunoglobulin E (IgE) or non-immunoglobulin E (non-IgE) inflammatory response affecting the cardiopulmonary and other systems. * **IgE-mediated response (anaphylactic shock)** is an antibody-antigen reaction against an allergen, such as milk, peanuts, latex, insect bites, or fish. This is the most common type * **Non IgE-mediated response (anaphylactoid reaction)** is a systemic reaction to infection, exercise, radio contrast material, or other triggers. While the response is almost identical to the other type, it does not involve IgE Typically, with IgE-mediated response, an antigen triggers release of substances, such as histamine and prostaglandins, which affect the skin, cardiopulmonary, and GI systems. Histamine causes initial erythema and edema by inducing vasodilation. Each time the child has contact with the antigen, more antibodies form in response, so allergic reactions worsen with each contact. In some cases, initial reactions may be mild, but subsequent contact can cause severe life-threatening response. Anaphylaxis syndrome may present with a few symptoms or a wide range that encompasses cardiopulmonary, dermatological, and gastrointestinal responses. Symptoms may recur after the initial treatment (biphasic anaphylaxis) in about 6% of children; therefore, careful monitoring is essential. Symptoms of anaphylaxis syndrome are: * Sudden onset of weakness, dizziness, confusion. * Severe generalized edema and angioedema. Lips and tongue may swell. * Urticaria. * Increased permeability of vascular system and loss of vascular tone. * Severe hypotension leading to shock. * Laryngospasm/bronchospasm with obstruction of airway causing dyspnea and wheezing. * Nausea, vomiting, and diarrhea. * Seizures, coma and death.