1/13. A study on severe food reactions in sweden--is soy protein an underestimated cause of food anaphylaxis?BACKGROUND AND methods: Because of a fatal case of soy anaphylaxis occurring in sweden in 1992, a study was started the following year in which all physicians were asked to report fatal and life-threatening reactions caused by food. The results of the first 3 years of the study are reported here, including results from another ongoing study on deaths from asthma during the same period. RESULTS: In 1993-6, 61 cases of severe reactions to food were reported, five of them fatal. Peanut, soy, and tree nuts seemed to have caused 45 of the 61 reactions, and four of them were fatal. If two cases occurring less than a year before our study started are included, we are aware of two deaths caused by peanuts and four deaths caused by soy. All four youngsters who died from soy anaphylaxis with asthma were severely allergic to peanuts but had no previously known allergy to soy. In most cases, there was a rather symptom-free period for 30-90 min between early mild symptoms and severe and rapidly deteriorating asthma. CONCLUSIONS: Soy has probably been underestimated as a cause of food anaphylaxis. Those at risk seem to be young people with asthma and peanut allergy so severe that they notice symptoms after indirect contact.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. food safety of allergic patients in hospitals: implementation of a quality strategy to ensure correct management.Food allergy could affect up to 8% of children. Four cases of food anaphylaxis in hospitalized children are reported, pointing to the need of food allergenic safety procedures in hospital settings. The implementation of the operating procedure in hospital food production units (HFPU) of Nancy University Hospital is described. The dietetics Department developed on hypoallergenic diet and specific avoidance diets. Dieticians within HFPU managed the choice of starting materials, the circuit organization in order to avoid any risk of contamination during preparation and cooking of food, product traceability, and trained the staff of HFPU. Within the care units physicians, dieticians, nurses, hospital workers are involved in meal management. A diet monitoring sheet is integrated into the patient's nursing file and enables the dietician to validate the diet in the computer, the nurses to display the patient's diet on the schedule on the wall in their office. The hospital workers finally use a tray form indicating the patient's identity, his/her diet and the menu of the day. Such a procedure absolutely secures the whole circuit and specifies the responsibilities of each person, whilst ensuring effective cooperation between all partners. Since 1999, the implementation of this multi-step strategy has prevented from any further reaction in a department specialized for food allergies in children and in adults. As setting up food allergenic safety in hospitals in not addressed adequately in the European directives, it's judicious to draw attention of hospital catering managers and hospital canteen staff to this necessity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Cow's milk allergic patients should be informed of the sources of caseinate.Cow's milk allergy is one of the most common food allergies prevalent during infancy and it may cause anaphylactic reactions in more sensitive patients. Cow's milk is found in a large variety of processed foods but its presence may be hidden as it is occasionally listed on the product label in an manner unrecognizable to the consumer. The parents of more sensitive patients need to be instructed in the detection of these potential sources of hidden cow's milk by judiciously reading food labels and in recognition of the sources, thus avoiding possible untoward reactions. We report a patient with cow's milk allergy who had an anaphylactic reaction following the ingestion of a hot dog product that contained caseinate. The label of the ingested hot dog product listed only the code number of caseinate. Avoidance of such occurrences would be more likely if firstly food products were labeled more accurately and secondly if physicians were to instruct their patients more thoroughly about their allergies, including the relevant names of all allergens.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. The elimination diet as a diagnostic tool.Many family physicians overlook the role that food and food additives play in health problems. An elimination diet is a safe and cost-effective method of evaluating adverse reactions to foods in some patients with common medical problems. patients whose symptoms improve or clear while they are on the diet are then challenged with the omitted foods one at a time to establish food-symptom relationships.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. Clinical holistic medicine: developing from asthma, allergy, and eczema.This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/13. Tahini, a little known sesame-containing food, as an unexpected cause of severe allergic reaction.We describe the case of a young woman with asthma and confirmed food allergy to sesame who had 2 severe systemic reactions after the inadvertent ingestion of tahini, a paste made with ground sesame seeds that is not generally known by physicians and patients as a sesame-containing food. A double-blind placebo-controlled food challenge confirmed the allergy to tahini in our patient. As new products and recipes are being introduced from around the world on a regular basis, it is essential that at-risk patients are able to obtain information about allergens used as ingredients and as potential contaminants. This should be applied not only to packaged food but also to freshly made foods, such as those served in restaurants.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. Late diagnosis of tree nut and sesame allergy in patients previously sensitized but tolerant to peanut.BACKGROUND: Recent studies have indicated that tolerance to peanut can occur in patients with a history of peanut allergy. Tree nut and sesame allergies have been reported to occur at increased incidence in patients with peanut allergy. Although the coexistence may be simply due to a predisposition to food allergy in these individuals, cross-reactivity has been demonstrated between peanut and tree nuts and between peanut and sesame seed. OBJECTIVE: To describe 3 patients previously sensitized but tolerant to peanut who were subsequently diagnosed as having either tree nut or sesame allergy. methods: All the patients had a clinical history of peanut sensitivity and underwent follow-up peanut skin testing to commercial extracts using a bifurcated needle followed by a graded peanut challenge. One patient had a previous positive radioallergosorbent test reaction to sesame and underwent a graded sesame challenge. RESULTS: All the patients had negative peanut challenge results. Two patients subsequently had exposure to tree nuts at home and had systemic reactions and positive skin test reactions to the incriminated tree nut. One patient had a positive challenge reaction to sesame. CONCLUSION: Demonstration of tolerance to peanut may falsely reassure patients and physicians that patients no longer need to avoid tree nuts or sesame. Tree nut and sesame allergies can exist or develop in patients despite the development of tolerance to peanut.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Urticarial contact dermatitis in food handlers.OBJECTIVE: To show that prick testing (using fresh samples of the food suspected from the patient's history) and not only patch testing is the appropriate investigation in selected cases of hand dermatitis in patients who spend considerable time handling foods (for example, catering workers, cooks). SETTING: The Contact and Occupational dermatitis Clinic at the skin and Cancer Foundation, a tertiary referral centre in Sydney. patients: Fourteen patients with hand dermatitis present for an average of 6.17 years referred by dermatologists and occupational health physicians. INTERVENTIONS: Patch and prick tests were performed for each patient. RESULT: In all patients prick tests identified the food allergens. seafood was the most common allergen giving positive results in 10 patients. patch tests did not identify any of the food allergens. Of the 14 patients nine were followed up and seven of these had been forced to change their career direction. CONCLUSION: Prick testing is the appropriate investigation in selected cases for the diagnosis of urticarial contact dermatitis in food handlers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Food and chemicals as environmental incitants.Susceptibility to environmental incitants such as air, food and water components is becoming an increasingly recognized health problem. These sensitivities and reactions can induce a spectrum of symptoms affecting smooth muscle, mucous membranes and collagen in the respiratory, gastrointestinal, genitourinary and vascular systems. These reactions may be mistaken for hypochondriasis, but actually are due to reactions to foods and chemicals found in the patient's home and work environments. Careful clinical histories should alert the nurse and physician, who can confirm suspicions by eliminating and challenging the patient with potentially offending agents under controlled circumstances.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Monosodium L-glutamate-induced asthma.Ingested chemicals, including aspirin and sulfites, are becoming increasingly recognized as provokers of acute severe asthma. In order to investigate the asthma-provoking potential of the widely used flavor enhancer, monosodium L-glutamate (MSG), we challenged 32 subjects with asthma, a number of whom gave histories of severe asthma after Chinese restaurant meals or similarly spiced meals. The subjects received an additive-free diet for 5 days before challenge and were challenged in hospital, after an overnight fast, with 500 mg capsules of MSG. They were challenged in a single-blind, placebo-controlled fashion with increasing doses of MSG from 0.5 gm to 5.0 gm. Thirteen subjects reacted. Seven subjects (group 1) developed asthma and symptoms of the Chinese restaurant syndrome 1 to 2 hours after ingestion of MSG. Six subjects (group 2) did not develop symptoms of Chinese restaurant syndrome, and their asthma developed 6 to 12 hours after ingestion of MSG. These challenge studies confirm that MSG can provoke asthma. The reaction to MSG is dose dependent and may be delayed up to 12 hours, making recognition difficult for both patient and physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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