Transcript 413 PHG lecture

May be I am
allergic to
flowers
Allergens
Hypersensitive Reactions
 Are
harmful antigen-specific immune
responses, occur when individual who has
been primed by an innocuous antigen
subsequently encounters the same antigen,
produced tissue injury and dysfunction.
Types of hypersensitivity：I、II、III、IV
Allergy
is one of four forms of
hypersensitivity and is called type I (or
immediate) hypersensitivity.
 Allergy is a disorder of the immune system that occur to
normally harmless environmental substances known as
allergens.
 It is characterized by excessive activation of certain
white blood cells called mast cells and basophils by a
type of antibody known as IgE, resulting in an extreme
inflammatory response.
An antigen reacts with cell fixed antibody (Ig E)
leading to release of soluble molecules
An antigen (allergen)
soluble molecules (mediators)
Allergens
Sulfonamide
drugs
salicylate
Penicillins
3 The process and mechanism of Type I hypersensitivity
1) Priming stage： last more than half a year
2) Activating stage：
Crosslinkage
Enzyme reaction
Degranulation of mast cell , basophil
3) Effect stage：
Immediate/early phase response: Mediated by histamine
Start within seconds
Last several hours
Late-phase response ：
Mediated by new-synthesized lipid mediators
Take up 8-12hours to develop
Last several days
Mechanism of type I hypersensitivity
Allergen
Primary
Individual
Generation
IgE
Adhesion
Secondary
IgE binds to the FceRI on mast cell and basophil
Allergen binds to the IgE on primed target cell
Crosslikage of FceRI
Degranulate and release the biological mediators
Preformed granule mediators
Histamine
Bradykinin
New generated mediators
Leukotrienes
PAF
Prostaglandin D2
Dilate capillaries,increase permeability, increase mucus secretion, contract smooth muscle
Systemic anaphylaxis
Skin
Respiratory tract
Degist tract
Allergy symptoms depend on route of
allergen entry
 Dust or pollen are airborne particles. In these cases,
symptoms arise in areas in contact with air, such as
eyes, nose and lungs. For instance, allergic rhinitis, also
known as hay fever, causes irritation of the nose,
sneezing, and itching and redness of the eyes.
 Inhaled allergens can also lead to asthmatic symptoms,
caused by narrowing of the airways
(bronchoconstriction) and increased production of
mucus in the lungs, shortness of breath (dyspnea),
coughing and wheezing
 Symptoms of food allergy include abdominal
pain, bloating, vomiting, diarrhea, itchy skin,
and swelling of the skin during hives. Food
allergies rarely cause respiratory (asthmatic)
reactions, or rhinitis.
 Substances that come into contact with the skin,
such as latex, are also common causes of allergic
reactions, known as contact dermatitis or
eczema. Skin allergies frequently cause rashes,
or swelling and inflammation within the skin.
 Insect stings, antibiotics, and certain medicines
produce a systemic allergic response that is also called
anaphylaxis; multiple organ systems can be affected,
including the digestive system, the respiratory system,
and the circulatory system.
 Depending of the rate of severity, it can cause
cutaneous reactions, bronchoconstriction, edema,
hypotension, coma, and even death.
 This type of reaction can be triggered suddenly, or the
onset can be delayed. The severity of this type of
allergic response often requires injections of
epinephrine, sometimes through a device known as the
EpiPen or Twinject auto-injector.
Atopy
* Local form of type I hypersensitivity
* Exposure to certain allergens that induce production of specific Ig E
* Allergens :
Inhalants:dust mite faeces, tree or pollens, mould spor.
Ingestants: milk, egg, fish, choclate
Contactants: wool, nylon, animal fur
Drugs: penicillin, salicylates, anesthesia insect venom
* There is a strong familial predisposition to atopic allergy
* The predisposition is genetically determined
Therapy of type I hypersensitivity
1. Allergen avoidance : Atopy patch test
2. Desensitivity therapy / Hyposensitization :
1) Allogenic serum desensitivity therapy:
Repeated injection small amounts of allergen,
2) Specific allergen desensitivity therapy
IgG+allergen
Neutralizing
Blocking
3. Drug therapy：
antibody,
antibody
1) Stabilization of triggering cells
•stabilize the membrane, inhibit mast cell degranulation
2) Mediator antagonism
•Antihistamine
•Bradykinin antagonism
3) Improve the responsibility of target organs
 Blood testing This kind of testing measures a "total IgE
level
 Skin testing preferred over blood allergy tests because it
is more sensitive and specific, simpler to use, and less
expensive.
 also known as "puncture testing" and "prick testing" due
to the series of tiny puncture or pricks made into the
patient's skin. Small amounts of suspected allergens
and/or their extracts (pollen, grass, mite proteins, peanut
extract, etc.) are introduced to sites on the skin marked
with pen or dye.
 If a serious life threatening anaphylactic reaction has
brought a patient in for evaluation, some allergists will
prefer an initial blood test prior to performing the skin
prick test. Skin tests may not be an option if the patient has
widespread skin disease or has taken antihistamines
sometime the last several days.
Diagnosis
Food allergy
The common allergens are:
 peanut
 egg
 milk
 fish
 crustaceans
 soy
 gluten Wheat
 sesame
 tree nuts walnuts,
almonds, cashews,
pistachios
 Food allergy
symptoms can include
one or more of the
following: Hives, rash,
tingling of the mouth
or throat, abdominal
cramps, vomiting,
diarrhea, swelling of
the face or tongue, or
difficulty breathing.
 People with the same
food allergy may have
different reactions.
Food allergies can be fatal
For your information
Peanut Allergies: Hidden Ingredients
 Arachis oil
 Ground nuts, ground peanuts
 Imitation walnuts or almonds
 Mixed nuts*
 Mixed nut butters
 Nut butters*
 Nut extracts*
 Nut flavorings*
 Peanuts
* May contain peanuts
 Peanut butter
 Peanut butter chips
 Peanut extract
 Peanut flavoring*
 Peanut flour
 Peanut oil
 Ground nut oil
 Peanut syrup
 Satay sauce*
Tree Nut: Hidden Ingredients
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Almonds
Brazil nuts
Cashews
Chestnuts
Filberts/hazelnuts
Gianduja*
Hickory nuts
Macadamia nuts
Marzipan/almond paste
Nougat
Nu-Nuts ® artificial nuts
* Gianduja is a creamy mixture of
chocolate and chopped nuts found in
premium or imported chocolate
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Nut butters (cashew butter)
Nut milks (almond milk)
Nut oil
Nut paste (almond paste)
Pecans (Mashuga nuts)
Pine nuts
Pistachios
Pralines
Pure almond or other nut extract
Walnuts
Wheat Allergy – Hidden Ingredients
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Bleached all-purpose flour
Bran
Bread, bread crumbs
Bulgur wheat, Durum wheat
Cake and pastry flour
Cereal extracts, cereal
binder, cereal filler, cereal
protein
Cracker meal
Cream of Wheat ®
Malt-O-Meal ®
Couscous
Durum
Enriched flour, bread flour
(white or wheat)
Farina
Flour, granary flour
 Gliadin
 Gluten
 Grain-based coffee
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substitutes
Graham cracker, graham
flour
Hydrolyzed protein
Hydrolyzed vegetable protein
Instant soup stock
Modified food starch
MSG (Monosodium
glutamate)
Pasta, noodles
Puddings, wheat thickeners
Soy sauce
Spelt, Triticale
Wheat Allergy – Hidden Ingredients
Vegetable starch
Vitamin E pills (some)
Wheat flour and wheat bran
Wheat germ, wheat starch
Wheat gluten, gluten flour
Wheat semolina, semolina
flour
 White (grain) vinegar
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•Oats, barley, rye, triticale, and spelt may
also cause problems for people with gluten
sensitivity.
•Buckwheat is an herb and does not contain
gluten. www.gluten.net
PLEASE NOTE:
•Stabilizers, spices and emulsifiers can
also indicate the presence of wheat
•Some alcoholic beverages (beer,
whisky and gin) may cause allergic
reactions in individuals with wheat
allergies.
Egg Allergy – Hidden Ingredients
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Albumin
Apovitellin
Batter
Cholesterol-free eggs
Custard
Dried egg
Egg, egg glazes
Eggnog
Egg noodles
Egg white solids
Egg yolks
Globulin
Lecithin (could be derived from soy)
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Livetin
Lysozyme
Marzipan
Mayonnaise
Meringue
Mouse
Ovalbumin
Ovamucoid/ovamucin
Ovovitellin/vitellin
Powdered or liquid eggs
Pudding
Quiche
Simplesse
Souffle
Milk Allergy: Hidden Ingredients
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Bechamel sauce
Butter, butter solids
Butter fat
Butter flavor
Buttermilk
Casein
Caseinates
Cheese (any kind)
Cottage cheese
Cream
Curds
Custard
Dried milk solids
Evaporated milk
Ghee
Half-and-half
High protein flour
Ice cream, ice milk
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Lactate solids
Lactoglobulin, lactalbumin
Lactose
Malted milk
Margarine
Milk (any kind, except soy)
Milk protein
Milk solids
Non-fat dry milk
Nougat
Pudding
Rennet
Sodium casein
Sour or whipping cream
Whey
Yogurt (any kind, except soy)
Soy Allergy: Hidden Ingredients
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Edamame soy bean
Hydrolyzed soy protein
Lecithin
Miso
Modified food starch
Natto
Shoyu sauce
Soy albumin
Soy beans (curds, granules)
Soy concentrate
Soy cheese
Soy flour
Soy grits
Soy meat, soy meal
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Soy milk, soy ice cream
Soy nuts
Soy oil
Soy protein concentrate
Soy protein isolate
Soy sauce
Soy sprouts
Soy yogurt
Tamari
Tempeh
Textured soy protein (TSP)
Textured vegetable protein (TVP)
Tofu
Soy Allergy: Hidden Ingredients
The following are label ingredients that may contain the presence of
soy protein:
 Hydrolyzed plant protein
 Hydrolyzed vegetable protein
 Natural flavoring
•Vegetable broth
•Vegetable gum
•Vegetable starch
Many gluten free products contain soy.
Check the label.
Fish/Shellfish Allergy: Hidden Ingredients
 Albone
 Clams (cherrystone, littleneck,
 Mussels
 Worcestershire sauce (may contain
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pismo, quahog)
Cockle (periwinkle, sea urchin)
Crab
Crawfish (crayfish, ecrevisse)
Fish oil capsules
Fish broth or stock
Lobster (langouste, langoustine,
coral, tomalley)
Mollusks
Parvalbumin is the protein in
fish that is known to provoke
allergic reactions.
anchovies)
Octopus
Oysters
Prawns
Scallops
Scampi
Shrimp
Snail
Squid (calamari)
Sushi
Fish/Shellfish Allergy: Hidden Ingredients
The following ingredients may indicate the presence of
protein:
 Bouillabaisse
 Fish stock
 Seafood flavoring (crab or clam extract)
 Surimi
shellfish
Corn Allergy: Hidden Ingredients
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Baking powder*
Cereals
Confectioner’s (powdered) sugar
Corn – ANYTHING!
Dextrin or maltodextrin
Dextrose, glucose, or fructose
Golden syrup (treacle)
Glucona delta lactone
High-fructose corn syrup
Hominy, grits
Invert sugar, invert syrup
Malt, malt syrup, malt extract
Modified food starch (may be
corn)
*Do not confuse with baking soda. Baking
powder contains a mixture of leavening agents
and a moisture-absorber such as cornstarch.
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Mono- and diglycerides
Monosodium glutamate (MSG)
Polenta
Sorbitol
Starch, food starch
Sucrose (may derive from corn)
Vanilla extract
Vegetable oil (may be corn)
Xanthan gum
Zein (protein from corn,
sometimes used in time-released
medications)
Substitutions for Corn
Featherweight Baking Powder or
Arrowroot
Latex Allergies
Proteins found in these items have a similar chemical
composition to latex and a reaction may occur from
consuming these foods:
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Banana
Avocado
Chestnut
Hazel Nut
Kiwi
Melons
Passion Fruit
Fig
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Tomato
Carrot
Celery
Papaya
Potato
Pineapple
Mango
Peach
Substitutions for Wheat Products
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Rice flour
Tapioca flour
Cornstarch
Potato Starch Flour
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Soy bean flour
Arrowroot
Cornmeal
Corn flour
Gluten Free Mix
6 cups of rice flour, 2 cups of potato starch flour, 1 cup of tapioca flour.
Combine, store in a cool, dry place for use as needed. Makes 9 cups.
Milk Substitutions
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Baked goods containing soy, rice or almond milks
Cornstarch puddings made with fruit juice
Frozen tofu desserts
Milk-free margarine (parve), salad dressings (almond milk)
Milk-free sherbets, ices and sorbets (Alpine Ice)
Milk-free or soy milk shakes
Nut, soy or rice milks
Soy cheese and soy yogurt
Some non-dairy creamers
Egg Substitutions
For each egg, try one of the following:
 1 packet of plain gelatin mixed with 2 tbsp warm water. Mix
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into other ingredients immediately before it thickens.
1 tsp. baking powder, 2 tbsp. Vinegar
1 tsp. yeast dissolved in ¼ cup warm water
1 tbsp. apricot puree
1 ½ tbsp. water, 1½ tbsp. cooking oil, &
tsp. baking powder
Egg Replacer, such as Ener-G®
tbsp. powder and 2 tbsp. water
1
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