Presentation on theme: "Common Food Sensitivities, Allergens, and Intolerances"— Presentation transcript:
1Common Food Sensitivities, Allergens, and Intolerances PEANUT ALLERGYWen Hsin Fan Pui Yin WongThaoly Nguyen
2Objective Define food sensitivity, intolerance, and allergy Common food and symptoms of food allergyMechanism of Food allergyDiagnosis and treatmentRecommendation from American Academy of PediatricsStudy agrees with the RecommendationStudy against the RecommendationStrengths and weaknessesConclusion
3Definition Food sensitivity: Food intolerance: Food allergy: undesirable response caused by psychological dislike towards certain foods rather than to the foods themselves.Food intolerance:as an inability to digest and absorb a component of specific food proteins cause by an enzyme defect.Food allergy:the involvement of immunological responses which characterized by immunoglobulin E (lgE) antibodies to food proteins.
6Diagnosis and Treatment Immunoglobulin E (lgE)Skin prick testTreatment:Immunotherapy (OIT), oralImmunotherapy (SLIT), sublingualImmunotherapy (ECIT), epicutabeous
7American Academy of Pediatric Recommendation Women with atopic diseases or have a family history (FH) of atopic symptoms should avoid the consumptions of dietary peanuts during pregnancy and lactation, and to avoid feeding peanuts to a child until age 3.However, the prevalence of peanut allergy in children doubled after the recommendation was initiated.This recommendation was withdrawn in 2000 due to lack of research support.
8Support the recommendations Vadas, P., et al. "Detection of Peanut Allergens in Breast Milk of Lactating Women." JAMA : the journal of the American Medical Association (2001): Print.
9Detection of Peanut Allergen in Breast Milk of lactating Women ObjectiveTo investigate the ability of maternal dietary peanut protein to pass into breast milk during lactation.Participant23 healthy, lactating women aged 21-35
10Detection of Peanut Allergen in Breast Milk of lactating Women MethodsSubjects are told to avoid legumes 24 hrs. prior breast milk collectionFasting overnightObtained breast milk at time 0 hr.Ingested 50g peanutBreast milk is collected at 1,2,3,4,6,8,12 hr.Result11/23 had detectable peanut protein in breast milk48% of total participant
11Figure 1. Time Course of Appearance of Peanut Protein in Breast Milk Subjects ingested 50 g of peanuts.Vadas, P. et al. JAMA 2001;285:Copyright restrictions may apply.
12Detection of Peanut Allergen in Breast Milk of lactating Women Identified Peanut ProteinAra h 1 (66kd)Ara h 2 (17kd)
13Conclusion Peanut allergen could be presented in breast milk Detection of Peanut Allergen in Breast Milk of lactating WomenConclusionPeanut allergen could be presented in breast milkMaternal peanut consumption may predispose at-risk children to develop sensitization.
14Pros Cons Small sample size No statistic method to analysis the data Detail explanation on the methodCollect a baseline data before peanut consumptionUsing graph & picture to present their resultSmall sample sizeNo statistic method toanalysis the dataProsCons
15Against the recommendations Objectives:To determine the prevalence of PA among Israel and UK Jewish children.Evaluate the relationship of PA to infant and maternal peanut consumptions.
16Du Toit, G. , Katz, Y. , Sasieni, P. , Mesher, D. , Maleki, S. J Du Toit, G., Katz, Y., Sasieni, P., Mesher, D., Maleki, S. J., Fisher, H. R., et al. (2008). Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. The Journal of Allergy and Clinical Immunology, 122(5),
171 2 3 2 1 3 Methods: Questionnaire determined prevalence of PA (FAQ) Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergyMethods:Questionnaire determined prevalence of PA (FAQ)2nd questionnaire assessed peanut consumption & weaning (FFQ)-Pupils-Parents1-Postal-Telephone2Validated against diagnostic criteria3Mother of Jewish infants ages 4-24 months1Explained the information2Compared & Completed( )3
18UK vs. Israel 1.85% (73/3943) 0.17% (8/4657) Adjusted RR= 9.8 Primary school children0.17% (8/4657)AdjustedRR= 9.8(CI )P < .0019 months of age 10%9 months of age 69%Monthly consumptions of PN in 1styear of life (8 - 14months ) = 0.0gMonthly consumptions of PN in 1st year of life (8 - 14months )= 7.1gMedian level ofconsumption/month=0consumption/month = 8breastfeeding (PN)PregnancyP < .001P=.004P=.06
19Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy ConclusionsPeanuts introduced earlier and is eaten more frequently and in larger qualities in Israel than UK.Jewish children in the UK have a prevalence of PA that is 10X higher than Jewish children in Israel.This findings raise the question of whether avoidance will actually prevent the development of PA in infants or early introduction of PN.
20environment into consideration socioeconomic class differences Large sample sizeAdminister questionnaires(March )Tested for the amount ofpeanut protein contentsDefinition of PALimited recall biasAllergy testingDid not take externalenvironment into considerationDid not further expand onsocioeconomic class differencesSome children with peanut allergywere not assessed clinicallyObtaining FA questionnairePROSCONS
21CONCLUSIONThe lack of understanding about the mechanism of PA and the available evidence does not support the accordance of peanuts during maternal exposure and the delayed introduction of peanuts in the diets of children.With FA diseases or symptoms should avoid the consumptions of peanut products. ( HIGHER CHANCE OF GETTING PA)
22Research Keywords – Peanut allergy AND Pregnancy PubMed – 41 articles CAB Abstract – 26 articlesLearn Early About Peanut Allergy (LEAP)
23ReferencesOtsu, K., & Dreskin, S. C. (2011, October 14). Peanut allergy: an evolving clinical challenge. Retrieved from DesRoches, A., Infante-Rivard, C., Paradis, L., Paradis, J., & Haddad, E. (2010). Peanut allergy: Is maternal transmission of antigens during pregnancy and breastfeeding a risk factor? Journal of Investigational Allergology & Clinical Immunology : Official Organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana De Alergia e Inmunologia, 20(4), Du Toit, G., Katz, Y., Sasieni, P., Mesher, D., Maleki, S. J., Fisher, H. R., et al. (2008). Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. The Journal of Allergy and Clinical Immunology, 122(5), Sicherer, S. H., Wood, R. A., Stablein, D., Lindblad, R., Burks, A. W., Liu, A. H., et al. (2010). Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants. The Journal of Allergy and Clinical Immunology, 126(6), Thompson, R. L., Miles, L. M., Lunn, J., Devereux, G., Dearman, R. J., Strid, J., et al. (2010). Peanut sensitisation and allergy: Influence of early life exposure to peanuts. The British Journal of Nutrition, 103(9), Vadas, P., et al. "Detection of Peanut Allergens in Breast Milk of Lactating Women." JAMA : the journal of the AmericanMedical Association ( 2001): Print.