Food AllergyBy Prof.Enayat Hashem

Food allergy is a condition that develops when a person is hypersensitive to certain proteins found in food.It is an immune response

Immnue response may be:1) Immediate reactions (life-threatening) Rapid appearance of symptoms often within minutes after the offending food eaten or before the food is swallowed.2) Late reactions (less severe) Up to 48 hours between eating the allergen food and the appearance of symptoms as nasal congestion.

Food allergen / antigens They are the proteins or other large molecules from food that induce an immune response.The immunoglobulin E (IgE) It is produced in response to these foreign substances in an attempt to rid the body from them. IgE causes the typical allergic symptoms that involve the skin, nasal passages , and respirator or G.I.T.

Food most often cause allergic reactions Milk Fish Shellfish Nuts Berries Chocolate Corn Wheat Legumes (green peas, beans and peanuts) Some fresh fruits (peach family)

Diagnosis of food allergy1) Medical diagnostic tests a. Skin testing by scratching the skin with extract of food b. Radioallergosorbent2) Nutritional diagnostic tests a. Detailed allergic history for previous 2 4 weeks b. Elimination diets

Elimination diets

This diet contain a few carefully chosen food with common allergens omitted. It should be followed for 1 2 weeks. Foods are slowly and cautiously put back into the diet, one food at a time for a few days. If no symptoms are noted, another food is added for another 2 days.

Nutritionally adequate diet without food allergen is advised.

Food Intolerance These do not involve the immune response, but food allergies do. They are not life-threatening. Food intolerance can begin at any age, while food allergy usually begins in childhood. Food intolerance may have a biological basis such as lack of digestive enzyme, or have a psychological basis as anorexia nervosa or bulimia.

Some common food intolerance Lactose intolerance Fat intolerance Intolerance to vegetables, fruits as legumes, lettuce Intolerance to hot, spicy food

Role of nurse in managing food allergies and food intolerance 1) The nurse needs to be aware of the medical basis and unknowns when it comes to problems with food. 2) The nurse should be supportive in listening to patients and their families describing food intolerance. 3) Judgments should be avoided, such as the idea that psychosomatic illness is all in the patients head.

4) The nurse should determine what valid testing has been undertaken to diagnose food allergies and intolreance.

5) Assessment should include asking patients what foods they cannot tolerate

6) If major groups , such as milk , are being omitted from the diet, the nurse or other health care professional should refer as needed to the patients primary

physician or as a registered dietitian or both. 7) The diagnosis should be confirmed when needed, and patient education should be provided to ensure good nutritional intake.

Anorexia nervosa It is characterized by refusal to eat, stemming from emotional states such as anxiety, irritation, anger, and fear. Initially there is no real loss of appetite. However, once severe weight loss has occurred, hormonal changes take place that can alter hunger recognition. The syndrome occurs mainly in girls after puberty, but about 10% of all cases of anorexia nervosa occurs in boys and young men. There is an increased risk of anorexia nervosa among high achievers and upper socioeconomic populations.

The cause is generally felt to be of psychological origin, but treatment involves more than just psychotherapy. Some common correlates of anorexia nervosa are:1) An intense fear of becoming obese that does not lessen as weight loss progresses.

2) A disturbance of body image, such as claiming to feel fat even when emaciated.

3) Weight loss at least 25% of original weight

4) Refusal to maintain body weight over a minimal healthy weight for age and height

5) No known physical illness that would account for weight loss.

6) Amenorrhea due to altered hormonal staes

7) Bizarre eating habits such as cutting food into tiny pieces or limiting intake to only few foods

8) Underlying low self-esteem

9) Compulsive excerise habits

Dietary treatment The goal of treatment is to restore nutritional status and resolve the underlying psycholog- ical problems. Outpatient treatment is the preferred method The person with anorexia who is 30% below normal weight, fails to gain weight, is in complete denial, or is suicidal should be hospitalized. All members of the health care team must be aware of the need to individualize the care plan.

The nurses role includes closely supervising and encourging the patient to eat all of the food provided. A trusting relationship between patient and health care professional is absolutely essential. It should be recognized that treatment will require a long-term, family based approach with considerable amount of time needed. Treatment is not always successful.

Bulimia It is characterized by binge eating followed by purging through self-induced vomiting or abusive use of laxatives or both. The person is afraid of becoming overweight and is aware that eating pattern is abnormal. However, the bulimic patient loses control over eating and often eats large amounts of food rapidly. High kilocalorie, easily ingested foods are chosen during binge episodes.

Fasting then follows, often resulting in a weight fluctuation of as much as 10 pounds. Bulimarexia is the term used to describe cycles of binge eating and purging (vomiting or laxative abuse) with undereating.

Dietary treatment In the hospital, food intake should be normalized to appropriate mealtimes, with close supervision after eating to control vomiting.

The patient must be counseled on the importance of the need to stop using laxatives and to accept a higher, but normal, body weight. Psychological assessment should take priority, and plans should be made for long-term, outpatient, family-based counseling with a health care professional trained in eating disorders. A total health care team efforts is essential to ensure effective treatment.

Outpatient dietary treatment of bulimia emphasizes regular mealtimes to satisfy hunger needs. Food is discouraged as a mean of reward or comfort.

Schizophrenia It is a chronic mental disorder that causes symptoms such as visual hallucination and delusions of hearing voices. A person with schizophrenia may feel that food has poisoned. A health care team approach is strongly advised. Any attempt to encourage eating may cause the person to become even more suspicious that the food has been poisoned. A great deal of patience when working with a person with schizophrenia.