1. Respiratory and skin manifestation of food allergy Dr. Naghi Dara Department of pediatric Gastroenterohepatology and nutrition Shahid Beheshti university of medical sciences Tehran, Iran 2016 In the Name of God

2. What is a Food Allergy?  Abnormal immunological response following exposure (usually ingestion) to a food  Body protecting itself – release of histamine Affects multiple body systems:  GI  Respiratory  Skin  Cardiovascular  Exposure can cause serious problems or death  Incidence 6-8%  50% of allergic reaction in first year of life  Majority of allergic reaction occurs during first three years of life.

3. Food allergy Food allergies are broadly categorized into l IgE-mediated  Rapid in onset, typically beginning within minutes to two hours from the time of ingestion  Reactions to carbohydrate allergens in meats, a type of reaction reported mainly in adults, represent an exception to this temporal pattern, since these reactions begin four to six hours after ingestion. l Non-IgE mediated l Mixed IgE and Cell mediated Atopic dermatitis or the eosinophilic gastrointestinal disorders, have characteristics of both mechanisms.

4. The Big 8 What the experts say l Eight foods account for > 90% of all reactions l Other allergens sesame seeds, food additives ( sulfite, tartarazin )

5. What are IgE mediated allergic symptoms? l Allergy symptoms can occur seconds to hours after ingestion of the allergen l Most common symptoms:  swelling, sneezing, nausea, GI distress Skin Swelling of lips, tongue & face Itchy eyes Hives ( urticarial ) Rash Diaphoresis Flushing Respiratory Tract Itching or tightness of throat Shortness of breath Dry or raspy cough Runny nose wheezing Gastrointestinal Tract Abdominal pain Nausea Vomiting Diarrhea Bloating Neurologic Sense of Impending doom, syncope dizziness seizures

6. Urticaria l Acute urticaria and angioedema is a most common manifestation of an IgE mediated allergic skin response to food. l Urticaria of < 6 weeks’ duration is arbitrarily considered “acute,”. l Generally appearing within minutes of ingestion of the food allergen. l Food allergy may account for 15 - 20 % of cases of acute urticaria. Urticaria recurring frequently for longer than 6 weeks is referred to as “chronic.” It seems that ~ 25% of patients with urticaria at some point will develop chronic urticaria.  Generally, 80% to 90% of patients with chronic urticaria do not have a cause that is well-described therefore In general, most studies suggest that foods provoke chronic urticaria in 1% to 2% of all patients who have chronic urticaria.  Diagnosis of acute urticaria provoked by a food may be evident from a straightforward history and confirmed by diagnostic test to detect food-specific IgE antibody..

7. Atopic Dermatitis l Classify as mixed IgE and Non IgE mediated reaction. l Approximately one third of infant/children with moderate to severe atopic dermatitis have food allergy. l Determination of the role of food allergy in patients with atopic dermatitis is more difficult and may require additional diagnostic maneuver including elimination diets and food challenges. l The diagnosis of food allergy in AD is complicated by several factors related to the disease: 1) The immediate response to ingestion of causal foods is downregulated with repetitive ingestion, making obvious “cause and effect” relations by history difficult to establish; 2) other environmental trigger factors (other allergens, irritants, infection) may play a role in the waxing and waning of the disease, obscuring the effect of dietary changes; and 3) patients have the ability to generate IgE to multiple allergens, making diagnosis based solely on laboratory testing impossible.

8. SIGNS & SYMPTOMS Itching Flushing Hives (urticarial) Swelling Dermatitis herpitiformis Atopic dermatitis Skin  IgE mediated  Non IgE mediated Non IgE mediated Dermatitis herpetic formis is characterized by an itchy papular vesicular eruption usually located symmetrically on the extensor surfaces of the elbows, knees, buttocks, sacrum, face, neck, trunk, and occasionally within the mouth. The predominant symptoms are itching and burning that are rapidly relieved with rupture of the blisters. Mixed IgE and Non-IgE mediated reactions

9. The following features characterize the relationship between atopic dermatitis and food. l The elimination of suspected food allergens frequently improves symptoms of atopic dermatitis within a few weeks. l Repeated exposure to suspect foods commonly exacerbates skin symptoms l Eliminating foods to which an infant has demonstrable allergy can partially improve skin symptoms Mixed IgE and non-IgE mediated

10. SIGNS & SYMPTOMS Itching Tearing Redness swelling around the eyes Eyes

11. SIGNS & SYMPTOMS Sneezing Runny noseNasal congestion Swelling of the tongueMetallic taste Nose & mouth

12. SIGNS & SYMPTOMS Difficulty breathing Coughing Chest tightness wheezing or other sounds Increased mucus production Throat swelling or itching change in voice horsness sensation of choking Lungs and throat

13. SIGNS & SYMPTOMS Dizziness weaknessFainting Rapid, slow, or irregular heart rate low blood pressure Heart and circulation

14. SIGNS & SYMPTOMS Anxiety confusion sense of impending doom Nervous system

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