Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerance

380 Pages·2009·2.02 MB·English

by  Isabel Skypala

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Food Hypersensitivity
Diagnosing and managing food
allergies and intolerance
Food Hypersensitivity: Diagnosing and managing food allergies and intolerance Edited by Isabel Skypala and Carina Venter
© 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-17036-9
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Food Hypersensitivity
Diagnosing and managing food
allergies and intolerance
Edited by
Isabel Skypala
BSc Nutrition and Dietetics, PG Dip Allergy, RD
Specialist Allergy Dietitian, Director of Rehabilitation
and Therapies,
Royal Brompton & Harefield NHS Trust,
andHonorary Senior Lecturer, Imperial College London
Carina Venter
BSc Dietetics, PG Dip Allergy, PhD, RD
Senior Allergy Dietitian, David Hide Asthma and Allergy
Research Centre, Isle of Wight,
andSenior Research Fellow, University of Portsmouth
A John Wiley & Sons, Ltd., Publication
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This edition first published 2009
© 2009 Blackwell Publishing Ltd
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Library of Congress Cataloging-in-Publication Data
Food hypersensitivity : diagnosing and managing food allergies and intolerance / edited
by Isabel Skypala, Carina Venter.
p. cm.
Includes bibliographical references and index.
ISBN 978–1–4051–7036–9 (pbk. : alk. paper) 1. Food allergy—Diagnosis.
2. Food allergy—Diet therapy. I. Skypala, Isabel. II. Venter, Carina.
RC596.F668 2009
616.97′50654—dc22
2008047431
A catalogue record for this book is available from the British Library.
Set in 10/12.5pt Sabon by Graphicraft Limited, Hong Kong
Printed in Singapore by Utopia Press Pte Ltd
1 2009
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Contents
List of contributors ix
Foreword xi
PART 1: DIAGNOSIS
1 Classification and Prevalence of Food Hypersensitivity 3
Carina Venter
1.1 Introduction 3
1.2 Nomenclature and classification 3
1.3 Immunological basis of food allergy 6
1.4 Symptoms associated with food hypersensitivity 9
1.5 Prevalence 9
1.6 Conclusion 17
2 The Role of Food Hypersensitivity in Different Disorders 22
2.1 The role of food hypersensitivity in skin disorders 22
Rosan Meyer and George Du Toit
2.2 The role of food hypersensitivity in respiratory disorders 31
Isabel Skypala
2.3 The role of food hypersensitivity in gastrointestinal disorders 37
Miranda Lomer
2.4 The role of food hypersensitivity in behavioural disorders 58
Donna C. McCann, Zoe Connor
2.5 The role of food hypersensitivity in neurological disorders 68
Sue Luscombe, Susan Thurgood
2.6 The role of food hypersensitivity in musculoskeletal disorders 81
Anna Carling
3 The Diagnosis of Food Hypersensitivity 85
Carina Venter, Berber Vlieg-Boerstra and Anna Carling
3.1 Introduction 85
3.2 Clinical history 85
3.3 Diagnostic tests 86
3.4 Complementary and alternative medicine 90
3.5 Diagnostic exclusion diets 92
3.6 Oral food challenges 94
3.7 Conclusion 103
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vi Contents
4 Triggers of Food Hypersensitivity 107
Isabel Skypala
4.1 Introduction 107
4.2 Allergens and the immune system 107
4.3 Food allergen classes and nomenclature 108
4.4 How does a food allergen induce allergy? 108
4.5 Classification of food allergens 109
4.6 Advances in food allergen technology 110
4.7 Peanut allergens 111
4.8 Food labelling 112
PART 2: DIETARY MANAGEMENT
5 Milk and Eggs 117
Tanya Wright and Rosan Meyer
5.1 Introduction 117
5.2 Cow’s milk 117
5.3 Egg allergy 128
6 Seafood 136
Isabel Skypala
6.1 Introduction 136
6.2 Prevalence and natural history 136
6.3 Foods involved 137
6.4 Diagnosis 139
6.5 Avoidance 142
7 Fruits and Vegetables 147
Isabel Skypala
7.1 Introduction 147
7.2 Prevalence and natural history 147
7.3 Foods involved 149
7.4 Presenting symptoms and diagnosis 157
7.5 Management 160
8 Peanuts, Legumes, Seeds and Tree Nuts 166
Ruth Towell
8.1 Peanuts 166
8.2 Other legumes 171
8.3 Seeds 174
8.4 Tree nuts 176
9 Food Hypersensitivity Involving Cereals 183
9.1 Coeliac disease 183
Norma McGough, Emma Merrikin and Emily Kirk
9.2 Allergy to wheat and other cereals 203
Isabel Skypala
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Contents vii
10 Other Causes of Food Hypersensitivity 210
Isabel Skypala
10.1 Reactions to food additives 210
10.2 Pharmacologic food reactions 221
10.3 Food-dependent exercise-induced anaphylaxis 229
PART 3: OTHER ASPECTS OF MANAGEMENT, ALLERGY PREVENTION AND
NUTRITIONAL CONSIDERATIONS
11 Nutritional Consequences of Avoidance, and Practical Approaches to
Nutritional Management 243
Ruth Kershaw
11.1 Introduction 243
11.2 Assessment of dietary adequacy 243
11.3 Factors affecting nutritional status 245
11.4 Ensuring optimal nutritional status while following a
food-avoidance diet 246
11.5 The nutritional consequences of avoiding a number of common
food allergens 247
11.6 Vitamin and mineral supplements 257
11.7 Other common nutritional issues encountered when implementing
food-avoidance diets 260
11.8 Conclusion 262
12 Lifestyle Issues 265
Tanya Wright
12.1 Introduction 265
12.2 The burden of anaphylaxis and food allergy 265
12.3 The importance of reintroduction of foods 265
12.4 Cross-contamination 266
12.5 Items on prescription 266
12.6 Recipe information 267
12.7 Product information 267
12.8 Awareness products 268
12.9 Nurseries, childminders and carers 268
12.10 Managing food allergy at school 269
12.11 Managing food allergy at home 270
12.12 Managing food allergy at work 271
12.13 Eating out 271
12.14 Going on holiday 272
12.15 Support and resources 273
13 Allergy Prevention and the Effect of Nutrition on the Immune System 278
Carina Venter
13.1 Introduction 278
13.2 Introduction to the immune system 279
13.3 Supporting the immune system through nutrition 282
13.4 Conclusions 294
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viii Contents
14 Management of Allergic Disease 303
14.1 Allergic rhinitis 303
Samantha Walker
14.2 Asthma 309
Jane Leyshon
14.3 Atopic eczema 315
Helen Cox
14.4 Anaphylaxis 322
Samantha Walker
Appendix 1: Patient information literature for a food challenge 329
Appendix 2: Food challenge protocol for adults 331
Appendix 3: Food challenge procedures 335
Appendix 4: Prolonged open food challenge procedures 337
Appendix 5: Food challenge form 339
Appendix 6: Food challenge symptom score chart 342
Appendix 7: Dietary management summaries 345
Index 355
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List of contributors
Anna Carling, BSc, PG Dip Allergy, RD
Senior Dietitian, Royal United Hospital, Bath NHS Trust
Zoe Connor, BSc, RD, MSc
Dietitian and Freelance Nutrition Consultant, www.nutritionnutrition.com
Helen Cox, MBChB, FRCP, FRCPCH, MD
Consultant in Paediatric Allergy and Immunology, Imperial College Healthcare
NHS Trust
George Du Toit, MBBCh, DCH, FCP, M Med, Dip Allergy, FRCPCH, FAAAAI
Consultant in Paediatric Allergy, Evelina Children’s Hospital, Guy’s & St Thomas’
NHS Foundation Trust and King’s College London
Ruth Kershaw, BSc, RD
Specialist Paediatric Allergy Dietitian, Lecturer in Human Nutrition and Dietetics
(Placement Support), London Metropolitan University Trust
Emily Kirk, MNutr, RD
Coeliac Disease Specialist Dietitian, Coeliac UK
Jane Leyshon, RGN, BA(Hons) Community Health Studies, PGCE
Head of Academic Studies, Education for Health Respiratory Nurse Specialist in
General Practice
Miranda Lomer, PhD, RD
Consultant Dietitian in Gastroenterology, Guy’s and St Thomas’ NHS Foundation
Trust and King’s College London
Sue Luscombe, Dip Allergy, RD
Specialist Dietitian, Bedford Hospital NHS Trust
Donna C. McCann, PhD, MA, PGCE
Visiting Research Fellow, School of Psychology, University of Southampton
Norma McGough, BSc, RD
Head of Diet & Health, Coeliac UK
Emma Merrikin, BSc, RD
Coeliac Disease Specialist Dietitian, Coeliac UK
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x List of Contributors
Rosan Meyer, B Dietetics, M Nutrition, PhD, RD
Paediatric Research Dietitian, Department of Paediatrics, Imperial College London
Isabel Skypala, BSc Nutrition and Dietetics, PG Dip Allergy, RD
Specialist Allergy Dietitian, Director of Rehabilitation and Therapies, Royal Brompton
& Harefield NHS Trust and Honorary Senior Lecturer, Imperial College London
Susan Thurgood, BSc, RD, Cert Nut Med
Senior Specialist Dietitian, Royal London Homoeopathic Hospital
Ruth Towell, BSc (Hons) Nutrition, MSc Teaching and Learning, RD
Clinical Research Dietitian, Paediatric Allergy, King’s College London and Guy’s
and St Thomas’ NHS Foundation Trust
Carina Venter, BSc Dietetics, PG Dip Allergy, PhD, RD
Senior Allergy Dietitian, David Hide Asthma and Allergy Research Centre, Isle of
Wight and Senior Research Fellow, University of Portsmouth
Berber Vlieg-Boerstra, PhD, RD
Clinical Research Dietician, Paediatric Allergy, University Medical Centre, Groningen,
The Netherlands and Specialist Allergy Dietician , Vlieg & Melse Dieticians, Arnhem,
The Netherlands
Samantha Walker, RGN, PhD
Director of Education & Research, Education for Health, Warwick and Honorary
Senior Lecturer (non-clinical), Division of Community Health Sciences, University
of Edinburgh
Tanya Wright, BSc, RD, MSc
Allergy Specialist Dietitian and Allergy Services Coordinator, Buckinghamshire
Hospitals NHS Trust