update on food allergy food allergen ... non- ige coeliac allergen bureau conference - vincent st...

Download Update on Food Allergy Food Allergen ... Non- IgE Coeliac Allergen Bureau Conference - Vincent St Aubyn

Post on 16-Feb-2020

0 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    1

    Update on Food AllergyUpdate on Food Allergy Food Allergen BureauFood Allergen Bureau

    Vincent St Vincent St AubynAubyn CrumpCrump FRCP(UK), FRACPFRCP(UK), FRACP

    Auckland Allergy ClinicAuckland Allergy Clinic October 14, 2008October 14, 2008

    B cell T lymphocyte

    Food protein

    IgE Antibody

    Mast cell/ Basophil

    Sensitization

    Elicitation/ Reactivity

    ALLERGY

    Skin- itchiness, flushing, hives, swelling, eczema GI- nausea, vomiting, abdominal pain, diarrhea Respiratory- tightness, runny nose, wheezing, throat closing/swelling Vascular- dizziness, low blood pressure, heart irregularities, shock

    Anaphylaxis Food

    •Subjective

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    2

    UK New Zealand

    Australia Republic of Ireland

    Canada Peru

    Costa Rica Brazil USA

    Paraguay Uruguay Panama

    Kuwait South Africa

    Malta Finland

    Lebanon Kenya

    Germany France Japan

    Thailand Sweden

    Hong Kong Philippines

    Belgium Austria

    Iran Argentina

    Estonia Nigeria

    Spain Chile

    Singapore Malaysia Portugal

    Uzbekistan Oman

    Italy Pakistan

    Latvia Poland Algeria

    South Korea Morocco

    Mexico Ethiopia

    India Taiwan Russia China

    Greece Georgia

    Romania Albania

    Indonesia

    0 5 10 15 20 25 30 35 40 Prevalence of asthma symptoms (%)

    12-month prevalence of asthma symptoms

    in ISAAC

    ISAAC Steering Committee Lancet 1998

    Admissions for Anaphylaxis in NHS Hospitals in the UK

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    3

    0.00%

    0.50%

    1.00%

    1.50%

    2.00%

    2.50%

    3.00%

    3.50%

    1989 '94-'95

    peanut sensitization Peanut Allergy

    Increasing Prevalence of Peanut Allergy in the UK

    Isle of Wight cohort study

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    4

    Atopic IcebergAtopic Iceberg Clinical Allergy

    •Eczema •Asthma

    •Hay Fever •Food Allergy

    Sensitized Atopic

    Latent Allergy (Potential to develop the disease)

    or

    Adverse reaction to a Food (Any abnormal reaction from food ingestion)

    Non-toxic

    Toxic Scombroid fish poisoning

    Bacterial food poisoning poisoning

    Psychologic intolerance Pavlovian conditioning

    oFood aversion

    Food Allergy (Immune)

    Food Intolerance (non-Immune)

    Metabolic Lactose Intolerance

    Pharmacologic Caffeine ‘anxiety’ Histamine sinsitivity Salicylate sensitivity

    Idiosyncratic Sulfite “sensitivity’

    IgE-Mediated (Immediate) Anaphylaxis Urticaria Asthma Atopic Derm Oral Allergy

    Mixed (IgE & non-IgE) [Intermediate]

    Esinophilic oesophagitis

    Non- IgE Coeliac

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    5

    The adverse reactions to foodsThe adverse reactions to foods Psychological / EmotionalPsychological / Emotional

    Psychological burden associated with genuine food allergy & intoPsychological burden associated with genuine food allergy & intoleranceslerances Psychological (conditioned) food responsesPsychological (conditioned) food responses

    Acute Acute urticariaurticaria (hives(hives) ) -- 20% in kids20% in kids EczemaEczema –– up to 60%up to 60% Oral Allergy SyndromeOral Allergy Syndrome --40% hay fever sufferers40% hay fever sufferers CoeliacCoeliac DiseaseDisease Asthma Asthma –– 5%5%

    SulfiteSulfite--inducedinduced GastrointestnalGastrointestnal SyndromesSyndromes

    EosinophilicEosinophilic EsophagitisEsophagitis Protein Protein enterocolitisenterocolitis Lactose IntoleranceLactose Intolerance

    Anaphylaxis Anaphylaxis –– 35%35% Fear & PhobiasFear & Phobias Death Death –– risk < ?risk < ?

    Prevalence of Food Allergy in young Prevalence of Food Allergy in young childrenchildren

    Food Food CountryCountry ______________Children__________________________________ _____ ______________Children__________________________________ _____ Adult Adult

    USA AUS FRA NOR CHINA DEN* UUSA AUS FRA NOR CHINA DEN* USASA

    Milk 2.5% 2.0% 1.1% 3.2% Milk 2.5% 2.0% 1.1% 3.2% 1.7% 0.65 0.3%1.7% 0.65 0.3%

    Egg 1.3% 3.2% 0.6% 2.0% Egg 1.3% 3.2% 0.6% 2.0% 3.0% 1.6% 0.2%3.0% 1.6% 0.2%

    Peanut 0.8% 1.9% 0.7% Peanut 0.8% 1.9% 0.7% -- 0.3% 0.3% 0.6%0.3% 0.3% 0.6%

    Tree nuts 0.2% 0.3% 0.7% Tree nuts 0.2% 0.3% 0.7% -- -- -- 0.5%0.5%

    Fish 0.1% 0.07 Fish 0.1% 0.07 -- -- 0.3% 0.3% -- 0.4%0.4%

    Shellfish 0.1% Shellfish 0.1% -- 1.4% 1.4% -- -- -- 2.0%2.0%

    Sesame Sesame -- 0.4% 0.4% -- -- -- -- --

    Overall 6% 7.77 6% Overall 6% 7.77 6% -- 5.2% 5.2% -- 3.7%3.7% * Point prevalence* Point prevalence

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    6

    Food Allergies causing Anaphylaxis Food Allergies causing Anaphylaxis in Canberra (60.9% of cases):in Canberra (60.9% of cases):

    Foods % Median AgeFoods % Median Age Peanut / tree nuts/ seeds: 26 Peanut / tree nuts/ seeds: 26 77

    Peanut 14.4 Peanut 14.4 44 Tree nut / seed 11.4 Tree nut / seed 11.4 1313 Peanut + Tree nut/seed 12.3 Peanut + Tree nut/seed 12.3 55

    Egg 11.4 Egg 11.4 33 Fruit / Vegetables 11.1 Fruit / Vegetables 11.1 3030 Wheat 6.7 Wheat 6.7 3131 Crustaceans 6.2 Crustaceans 6.2 3434 Scaly fish 5.1 Scaly fish 5.1 13 13 CowCow’’s milk 4.4 s milk 4.4 33 Soy 1.9 Soy 1.9 2020 Meat 1.6 Meat 1.6 2929 GelatineGelatine 0.9 0.9 5454 Alginate (seaweed) thickener 0.2 Alginate (seaweed) thickener 0.2 4040

    Mandatory Food Allergen/Food Mandatory Food Allergen/Food Intolerance Labelling ANZFAIntolerance Labelling ANZFA

    Cereals containing gluten and their products (wheat, rye, Cereals containing gluten and their products (wheat, rye, barley, oats and spelt and their hybridised strains) barley, oats and spelt and their hybridised strains) CrustaceaCrustacea (e.g. crayfish, crabs, prawns) and their (e.g. crayfish, crabs, prawns) and their products products Egg and egg products Egg and egg products Fish and fish products Fish and fish products Milk and milk products Milk and milk products Nuts and sesame seeds and their products Nuts and sesame seeds and their products Peanuts and soybeans, and their products Peanuts and soybeans, and their products Added sulphites in concentrations of 10mg/kg or more Added sulphites in concentrations of 10mg/kg or more

  • Allergen Bureau Conference - Vincent St Aubyn Crump

    7

    Mandatory labelling contd.Mandatory labelling contd.

    Food products containing these substances Food products containing these substances must be declaredmust be declared when present as: when present as: An ingredient An ingredient An ingredient of a compound ingredient An ingredient of a compound ingredient A food additive or component of a food additive A food additive or component of a food additive A processing aid or component of a processing A processing aid or component of a processing aid aid These allergens can be declared in the These allergens can be declared in the ingredient list ingredient list

    Mandatory food allergens in EUMandatory food allergens in EU celerycelery cereals containing gluten (including wheat, rye, barley and oatscereals containing gluten (including wheat, rye, barley and oats) ) crustaceans

Recommended

View more >