1. Le allergie alimentari multiple
Giampaolo Ricci
Università di Bologna

2. Allergie alimentari multiple
Definizione -epidemiologia
Quadri clinici
Quali rischi
Problemi nutrizionali

8. The natural history of cow's milk protein allergy/intolerance.
Høst A1, Jacobsen HP, Halken S, Holmenlund D.
Associated adverse reactions to other foods, especially egg, soy, peanut and citrus develop in about 41-54%
Eur J Clin Nutr Sep;49 Suppl 1:S13-8.

9. ……almost 50% non IgE mediated CMA react to soy …….

10. Nella real life pediatrica 78% hanno allergie alimentari multiple (3,4/persona)

11. Allergie alimentari multiple
Definizione -epidemiologia
Quadri clinici
Quali rischi
Problemi nutrizionali

16. Clinical features of food protein-induced enterocolitis syndrome
Chronic
Acute
Signs and symptoms
Intermittent, chronic vomiting
Chronic, watery diarrhea with blood/mucus
Lethargy
Pallor
Dehydration
Abdominal distension
Weight loss
Failure to thrive
Repetitive vomiting every 10 to 15 minutes, onset one to three hours after ingestion (>90%)
Diarrhea, onset approximately five hours after ingestion (<50%)
Lethargy (70%)
Pallor (70%)
Hypotension (15%)
Hypothermia (25%)

18. 15% poly food sensitization at 12 months

19. 11% poly food sensitization at 24 months
18% poly food sensitization during the first 2 years of life

21. Early-life SPT to common food allergens can provide valuable information in predicting the risk of sensibilization and food allergy into adolescence in individuals at high risk
Altough a small proportion of children may develop late-onset food sensitization, it is unlikely to be clinically relevant.

22. ‘HealthNuts’, a population-based, longitudinal food allergy study in Melbourne, 5276 infants
aged 11–15 months were recruited through 131 council-run immunization sessions from September 2007 to August 2011.

23. Diversi fenotipi/endotipi
Class 1: No allergic disease (70%).
The no allergic disease.The estimated prevalence of an episode of wheeze was 17%.
Class 2: Non-food-sensitized eczema (16%).
late-onset (≥ 4 months) eczema (60%), prevalence of wheeze was 24%.
Class 3: Single egg allergy (9%).
Half the infants had eczema (27% early-onset and 23% late-onset ) and 15% had wheeze.
Class 4: Multiple food allergies (predominantly peanut) (3%).
Approximately half (56%) were also allergic to egg, the prevalence of eczema was 72%, with early-onset eczema being more common (42%), whilst 23% had a history of wheezing.
Class 5: Multiple food allergies (predominantly egg) (2%).
egg ( prevalence 91%), sesame (50%) and peanut (39%). Early-onset eczema had the highest prevalence (58%), and an additional 31% were estimated to have reported late-onset eczema. The estimated prevalence of the history of wheeze was 14%.

26. POLLEN FOOD SYNDROME
Patients are sensitized to pollen allergenic molecules highly cross-reacting with their homologues in the offending foods
OAS can also be the clinical expression of primary sensitization to genuine and/or cross-reacting
food allergens and it is frequently the first symptom of an
allergic reaction in cases followed by systemic symptoms

32. POLLEN FOOD SYNDROME ( endotypes)
MONO-PANALLERGEN
MULTI-PANALLERGEN
NO PANALLERGEN
Bet v 1
Pru p 3
Phl p 12
Mastrorilli C et al, Allergy 2016

33. Allergie alimentari multiple
Definizione -epidemiologia
Quadri clinici
Quali rischi
Problemi nutrizionali

35. Aumenta il rischio di severità della allergia alimentare

36. Aumenta il rischio di comorbidità allergiche

37. Aumenta il rischio di asma

39. Aumenta il rischio di asma

40. Individuals with increased diversity of IgE against multiple components or epitopes may be more likely to experience severe reactions, but such diagnostic tools are not routinely available.

41. Allergie alimentari multiple
Definizione -epidemiologia
Quadri clinici
Quali rischi
Problemi nutrizionali

45. Speranze ?

47. Le allergie alimentari multiple: sintesi finale
Condizione frequente
Quadri clinici molto diversi con età di esordio differente
Patogenesi IgE e non IgE-mediata
Si associano ad una maggiore severità clinica
Attenti ai problemi nutrizionali

49. Grazie