Dr. Amal Kokandi (MB,BCh, MSc, MD) Assistant professor, Consultant dermatologist April 2010

Good news The largest observational study so far to examine the association between chocolate consumption and risk of cardiovascular disease has found that those who ate the most chocolate--around 7.5 g per day--had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate (1.7 g per day). (German Institute of Human Nutrition, Nuthetal, Germany) Buijsse, B, Weikert C, Drogan D et al. Chocolate consumption in relation to blood pressure and risk of CV disease in German adults. Eur Heart J 2010: DOI: /eurheartj/ehq068. Available at:

Adverse reactions to food Non toxic Immune mediated (food allergy) IgE mediated Non IgE mediated Non-immune mediated (food intolerance) Enzymatic Pharmacolo gical Others (neurologic & psychologic) Toxic

IgE mediated food allergy Quick onset Reproducible Typical symptoms Typical foods Positive tests

Epidemiology Self reported ranges from 3-35% Oral food challenges (OFCs) proved ranges from % More than 20% of adults & children alter their diet because of perceived belief of averse reaction to food or allergy

Symptoms The most common food allergy symptoms include: Tingling in the mouth Hives, itching or eczema Swelling of the lips, face, tongue and throat, or other parts of the body Wheezing, nasal congestion or trouble breathing Abdominal pain, diarrhea, nausea or vomiting Dizziness, lightheadedness or fainting

Anaphylaxis Constriction and tightening of airways A swollen throat or a lump in your throat that makes it difficult to breathe Shock, with a severe drop in blood pressure Rapid pulse Dizziness, lightheadedness or loss of consciousness anaphylaxis can cause a coma or death.

Other forms of food allergy Exercise-induced food allergy Pollen-food allergy syndrome or oral allergy syndrome Latex associated food allergy (banana, avocado, kiwi, papaya and apricot) Note: latex can induce delayed type hypersensitivity PARTIAL LIST: Band-Aids, rubber bands, erasers, some shoes and articles of clothing, balloons, surgical gloves, catheters, condoms, some items of sporting equipment, blood pressure cuffs, some watch bands, helmets, tooth brush massagers, bowling balls and ventilator tubing

Diagnosis History +associated conditions Allergy testing Skin prick testing (commercial and fresh food) Serum specific IgE Oral food challenge (open and blinded)

Allergy testing Suspected allergens Common allergens Common associations Egg and peanut Milk and soy Peanut with sesame, tree nuts and lupin Cross sensitisation and common reactivity Not to miss contamination Do not test if tolerated

Major allergens (FDA required labeling) Cow’s milk Egg Wheat Peanut +Sesame and kiwi Soy Tree nuts (such as almonds, cashews and walnuts) Fish (bass, cod and flounder) Shellfish (crab, lobster and shrimp)

Management Allergen avoidance Consider other allergens Dietetic education Supplementations Food labelling Hidden allergens

Management Recognition & treatment of reactions Education and follow up antihistamines Adrenaline autoinjectors and labels Severity of previous reaction, presence of bronchial asthma, peanut allergy Co morbidities Follow up

Problems with avoidance Total avoidance Labeling Hidden allergens

Tooth paste natural fruit extracts such as citrus and strawberries Arachis oil (peanut), coconut, sesame & tree nut oils Wheat, oat, barly Makeup wheat, sesame oil, soy Medications, vitamins & supplements Lactose, starch, glucosamine products in shellfish allergies (made from oyster or other shell fish) Hair products Wheat, citrus oil, mushroom oil, almond, soy.. Adhesives Wheat (envelope and stamp licking)

Impact of food allergy diagnosis Risk of fatal reactions Quality of life worse than type I DM Risk of compromised nutrition, dietary advise is crucial, supplementation Shopping and social events Economical problems

Web sites of interest World allergy organization site Food allergy & anaphylaxix network Mayo clinic web site About.com