1. Food Allergy I Rachanont hiranwong
lastelixer@gmail.com
18 feb 2009
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1299
Wednesday, February 18, 2009
13. Signs and Symptoms
RESPIRATORY
Congestion, itching,
sneezing, runny nose
Laryngeal edema, cough,
hoarseness
Wheezing, shortness of
breath, chest tightness
CARDIOVASCULAR
Feeling of faintness
Syncope
Hypotension/shock
Arrhythmias
Wednesday, February 18, 2009
14. Diagnosis
History: symptoms, timing, reproducibility
Acute reactions vs chronic disease
Diet details: specific causal food(s)
“Hidden” ingredient(s) less likely
Physical examination: evaluate other allergic conditions
Identify general mechanism
Is it food related at all?
Allergy vs. intolerance
IgE versus non-IgE mediated
Wednesday, February 18, 2009
15. Diagnosis
Suspect IgE-mediated
Prick skin tests (commercial or fresh food)
CAP RAST
Suspect non-IgE-mediated
Consider elimination diet, GI evaluation
Suspect non-allergic, consider:
Breath hydrogen test (lactose intolerance)
Sweat test (cystic fibrosis)
Endoscopy
Wednesday, February 18, 2009
17. Skin prick test (SPT)
Skin prick test (SPT) เป็นวิธี
ที่ไว และถูกที่สุดในการวินิจฉัย
การแพ้อาหาร สามารถทําได้
โดยไม่ต้องมีสารมาตรฐาน
เปรียบเทียบ แต่ผู้เชี่ยวชาญ
บางคนก็แนะนําให้ใช้น้ํา
แอปเปิ้ลสดเป็นตัวควบคุมเพื่อ
rule – out Non IgE
mediated reaction
ood extracts are rarely available for use in skin
diagnose food allergy. However, a few food
een validated in clinical trials in children and
a double blind, placebo controlled food
e gold standard. Foods that have been validated
ude cod, peanuts, cows’ milk, hens’ eggs, shrimps,
In many cases it is better and more convenient to
for skin prick testing. A drop of liquid food or a
ood is placed on the forearm and pricked
rick-prick” method). Fresh fruit can be used for skin prick testing for fruit allergy
Cross reactivity between birch pollen and apple in patient with
springtime hay fever and oral allergy syndrome after ingestion of
apple
y should point towards
ween intake of a specific
d onset of symptoms
cribed by the patient should be
ic type (namely, immediate allergic
ten from two or more organs)
ivo or in vitro — skin prick test,
Case history
Symptoms
Clinica
on 4 January 2009bmj.comDownloaded from
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ardised food extracts are rarely available for use in skin
esting to diagnose food allergy. However, a few food
ts have been validated in clinical trials in children and
by using a double blind, placebo controlled food
nge as the gold standard. Foods that have been validated
way include cod, peanuts, cows’ milk, hens’ eggs, shrimps,
y beans. In many cases it is better and more convenient to
sh fruits for skin prick testing. A drop of liquid food or a
of solid food is placed on the forearm and pricked
gh (the “prick-prick” method). Fresh fruit can be used for skin prick testing for fruit allergy
Cross reactivity between birch pollen and apple in patient with
springtime hay fever and oral allergy syndrome after ingestion of
apple
atient's history should point towards
e relation between intake of a specific
or additive and onset of symptoms
ymptoms described by the patient should be
"classic" atopic type (namely, immediate allergic
toms, most often from two or more organs)
Case history
Symptoms
Clinical revie
on 4 January 2009bmj.comDownloaded from
Wednesday, February 18, 2009
18. ImmunoCAP Test
ImmunoCAP Test เป็น
IgE fluoroenzyme
immunoabsorbent
assay ระดับของ IgE ที่
ตรวจจับได้คือ 0.1 -100
(แต่ threshold levels แค่
0.35) ผลจากการตรวจ
ออกมาเป็นตัวเลขที่มี
หน่วยเป็น KUA/I
Wednesday, February 18, 2009
