Academic literature on the topic 'Food-induced symptoms'

Introduction and objectives: The aim of the study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and the trigger factors in the group of the youngest children. The additional aim of the study is to estimate the frequency of anaphylaxis episodes in the population of children in the Kuyavian–Pomeranian Voivodeship.Methods: Retrospective analysis of medical records of 29 children aged 0–3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data.Results: The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0–3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12 ± 9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, that is, in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002).Conclusions: The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow’s milk after first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

Introduction and objectives: The aim of this study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and triggering factors in a group of youngest children. Also, the study aims to estimate the frequency of anaphylaxis episodes in children in the Kuyavian-Pomeranian Voivodeship region.Methods: Retrospective analysis of medical records of 29 children aged 0–3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data.Results: The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0–3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12±9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, i.e., in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002).Conclusions: The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow’s milk after the first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of ‘trigger’ foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.

Non-IgE (immunoglobulin E) mediated gastrointestinal food allergies include several separate clinical entities, including food protein‐induced allergic proctocolitis (FPIAP) and food protein‐induced enteropathy (FPE). Although FPIAP and FPE both primarily affect the gastrointestinal tract, their presentations are vastly different. FPIAP presents with bloody stools in otherwise healthy infants, whereas FPE presents with chronic diarrhea, vomiting, malabsorption, and hypoproteinemia. These both typically present in infancy and resolve by early childhood. Although the presenting signs and symptoms may be different, management is similar in that both require avoidance of the suspected causal food.

Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children. It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge. There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score. Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis. Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined. The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction. At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions. The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors. The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity. Delayed adrenaline administration is associated with higher incidence of severe course and death. Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors.

Background The prevalence of reported food hypersensitivity among children has increased in Western countries. However, the prevalence varies largely due to differences in methods used in different studies. Double-blind placebo-controlled food challenge (DBPCFC) is the most reliable method to verify or exclude food hypersensitivity. The use of double-blind food challenges is increasing in clinical praxis, but since the method is time- and resource consuming it is rarely used in population-based cohort studies. There is a lack of knowledge on how adolescents and mothers experience participation in double-blind placebocontrolled food challenges and to what extent the food is reintroduced after a negative challenge. While several studies have described the impact of IgEmediated food allergy on Health-Related Quality of Life (HRQL), few studies have described HRQL among children with other food hypersensitivity phenotypes. Aim The aim of this thesis was to estimate the prevalence of reported food hypersensitivity, associated risk factors, and symptom expressions among schoolchildren. We also examined HRQL among children with total elimination of cow’s milk, hen’s egg, fish or wheat due to food hypersensitivity as a group compared with children with unrestricted diet, and after we categorised the children with eliminated foods into different phenotypes of FHS. Finally, adolescents’ and mothers’ experience of DBPCFC was examined as well if the food had been reintroduced. Methods Three studies were based on the Obstructive Lung Disease in Northern Sweden (OLIN) paediatric cohort II. The cohort was recruited in 2006 when all children in first and second grade (7-8 years) in three municipalities in Norrbotten were invited to a parental questionnaire study and 2,585 (96% of invited) participated. The questionnaire included questions about food hypersensitivity, asthma, rhinitis, eczema and possible risk factors. The children in two municipalities were also invited to skin prick testing with 10 airborne allergens, and 1,700 (90%) participated. Paper I is based on this initial survey of the cohort. Four years later, at age 11-12 years, the cohort was followed up using the same methods and with the same high participation rate. At the follow-up, 125 children (5% of the cohort) reported total elimination of cow’s milk, hen’s egg, fish or wheat due to food hypersensitivity. These children were invited to a clinical examination and to complete a generic (KIDSCREEN-52) and a diseasespecific HRQL questionnaire (FAQLQ-TF) (n=75). Based on the clinical examination the children were categorised into different phenotypes of food hypersensitivity: current food allergy, outgrown food allergy and lactose intolerance. In addition, a random sample of children with unrestricted diet from the same cohort, answered the generic questionnaire (n=209). Paper II is based on this HRQL study. Children categorised as having current food allergy were invited to a further evaluation including DBPCFC. Eighteen months after the challenges, these children were interviewed about their experiences during and after the challenge (n=17). Paper III is based on these interviews. Paper IV was based on interviews with mothers to children referred to a paediatric allergy specialist for evaluation of food allergy using DBPCFC (n=8). In the two interview studies results were analysed using qualitative content analysis. Results At age 7-8 years, the prevalence of reported food hypersensitivity was 21%. Food hypersensitivity to milk, egg, fish, wheat or soy was reported by 10.9% and hypersensitivity to fruits or nuts by 14.6%. The most common essential food to trigger symptoms was milk, reported by 9%. The most frequently reported food induced symptoms, were oral symptoms mainly caused by fruits, followed by gastrointestinal symptoms mainly caused by milk. The risk factor pattern was different for food hypersensitivity to milk compared to hypersensitivity to other foods. No significant difference in distribution in generic or disease-specific HRQL was found among children with reported total elimination of milk, egg, fish and/or wheat due to FHS compared to children with unrestricted diet. However, a trend indicated that the disease-specific HRQL was most impaired among children with current food allergy compared to children with outgrown food allergy and lactose intolerance. The proportion of poor HRQL defined as ≥75 percentile was significantly higher among children with current food allergy than the other phenotypes. A DBPCFC was an opportunity for the adolescents and the mothers to overcome the fear of reactions to food that had been eliminated for a long time. After the challenge, when the food was partially or fully reintroduced, socializing became easier and both adolescents and mothers experienced more freedom regarding food intake. A negative challenge was not consistently associated with reintroduction of the food. Reasons for reintroduction failure were fear of allergic reactions, that the adolescent did not like the taste of the food, or that living with an elimination diet was considered as normal. Conclusion In this population-based study, one in five of children at age 7-8 years reported food hypersensitivity to any food. The generic HRQL was similar among children with and without food hypersensitivity. However, poor disease-specific HRQL was more common among children with current food allergy compared to children with other FHS phenotypes. If the tested food was reintroduced after a DBPCFC, both adolescents and mothers described a changed life with less fear, and that life had become easier regarding meal preparations and social events. As reintroduction failure was present despite a negative food challenge, follow-ups and evaluations of food reintroduction should be performed independent of the outcome of a food challenge.
Bakgrund Andelen barn med rapporterad födoämnesöverkänslighet har ökat. Prevalensen varierar mycket beroende på var studien genomförts och vilka metoder som använts. Dubbel-blinda placebo-kontrollerade födoämnesprovokationer (DBPCFC) är den mest tillförlitliga metoden för att utesluta eller verifiera födoämnesöverkänslighet. I klinisk praxis används DBPCFC alltmer, men eftersom metoden är resurskrävande används den sällan i populationsbaserade studier. Det saknas kunskap om mödrars och tonåringars egna upplevelser av att delta i DBPCFC och i vilken utsträckning livsmedlet återintroduceras efter en negativ provokation. Studier har beskrivit IgE-medierad födoämnesallergi och dess påverkan på hälsorelaterad livskvalitet men det saknas studier om livskvalitet bland barn med andra fenotyper av födoämnesöverkänslighet. Syfte Syfte med avhandlingen var att undersöka rapporterad förekomst av födoämnesöverkänslighet, riskfaktorer och symtomyttringar bland skolbarn. Vi har även studerat hälsorelaterad livskvalitet bland barn som helt eliminerat baslivsmedel, som hel grupp jämfört med barn utan eliminerad föda, samt efter att barnen kategoriserats i olika fenotyper av födoämnesöverkänslighet. Ett ytterligare syfte var att beskriva ungdomars och mödrars upplevelser, konsekvenser av DBPCFC samt i vilken omfattning livsmedlet återintroducerades. Metod Tre studier baseras på en barnkohort som rekryterades 2006 inom OLIN studierna (Obstruktiv Lungsjukdom i Norrbotten). Kohorten innefattade alla barn i årskurs 1 och 2 (7-8 år) i Luleå, Kiruna och Piteå där 2585 (96 % av de inbjudna) deltog i en föräldrabesvarad enkät. Enkäten innehöll frågor om födoämnesöverkänslighet, astma, rinit, eksem och möjliga riskfaktorer. Barn från Kiruna och Luleå inbjöds även till pricktest med 10 luftburna allergen och 1700 (90 %) deltog. Artikel I baseras på denna initiala enkätstudie. Fyra år senare följdes kohorten upp med samma metoder och höga deltagande. Totalt 125 barn (5 % av kohorten) uppgav total elimination av mjölk, ägg, fisk och/eller vete på grund av födoämnesöverkänslighet. Dessa barn inbjöds till en klinisk undersökning och 94 barn deltog. Sjuttiofem (80 %) av dessa barn besvarade hälsorelaterade livskvalitetsfrågor innefattande det generiska mätinstrumentet KIDSCREEN-52 samt det sjukdomsspecifika frågeformuläret FAQLQ-TF. Frågeformuläret KIDSCREEN-52 skickades även till ett slumpurval av barn utan eliminationskost från samma kohort, och 209 barn (65 %) deltog. Artikel II baseras på denna hälsorelaterade livskvalitetsstudie. Baserat på den kliniska undersökningen kategoriserades barnen med eliminerad kost i olika fenotyper av födoämnesöverkänslighet: pågående födoämnesallergi, utläkt födoämnesallergi och laktosintolerans. De barn som bedömdes ha pågående födoämnesallergi inbjöds till DBPCFC. Arton månader efter provokationen intervjuades deltagarna om sina upplevelser av provokationen och i vilken omfattning livsmedlet återintroducerades. Artikel III baseras på dessa intervjuer. Den fjärde studien baseras på intervjuer av mödrar vars barn remitterats till en pediatrisk barnallergolog för utredning av misstänkt födoämnesallergi med DBPCFC. Intervjuerna har analyserats med kvalitativ innehållsanalys. Resultat Vid 7-8 år var prevalensen av rapporterad födoämnesöverkänslighet 21 %. Överkänslighet mot basföda (mjölk, ägg, fisk, vete eller soja) rapporterades av 10.9% och 14.6% uppgav att de reagerade på frukt eller nötter. Klåda i munnen var det vanligaste rapporterade födoämnesutlösta symtomet som huvudsakligen orsakades av frukt. Det näst vanligaste symtomet var mag- och tarmbesvär, huvudsakligen orsakat av mjölk. Riskfaktormönstret för födoämnesöverkänslighet mot mjölk skiljde sig från överkänslighet mot andra födoämnen. Vi fann ingen statistiskt signifikant skillnad i generisk eller sjukdomsspecifik hälsorelaterad livskvalitet mellan barn som helt eliminerat mjölk, ägg, fisk eller vete på grund av födoämnesöverkänslighet jämfört med barn utan eliminerad kost. En trend indikerade att barn med pågående födoämnesallergi hade sämre sjukdomsspecifik hälsorelaterad livskvalitet jämfört med barn med utläkt födoämnesallergi eller laktosintolerans. Dålig livskvalitet, definierat som den ≥75e percentilen i det sjukdomsspecifika frågeformuläret, var vanligast hos barn med pågående födoämnesallergi. Deltagande i DBPCFC var en möjlighet för tonåringar och mödrar att övervinna rädslan för födoämnesorsakade symtom. I de fall då det testade livsmedlet helt eller delvis återintroducerades efter provokationen, upplevde både tonåringarna och mödrarna att det sociala umgänget blev lättare och att de inte längre behövde ha samma kontroll över födoämnesintaget. Ett negativt provokationsutfall resulterade inte alltid i att det testade livsmedlet återintroducerades i kosten. Orsaker till att inte återintroducera födoämnet var rädsla för allergiska reaktioner, att livsmedlet inte smakade gott och att det upplevdes som normalt att leva ett liv utan det eliminerade livsmedlet. Slutsats Vart femte barn rapporterade någon form av födoämnesöverkänslighet i denna populationsbaserade studie. Det var ingen signifikant skillnad i generisk livskvalitet mellan barn med och utan födoämnesöverkänslighet men barn med pågående födoämnesallergi tenderade att ha sämre sjukdomsspecifik livskvalitet jämfört med barn med utläkt födoämnesallergi och laktosintolerans. De deltagare som återintroducerade det testade livsmedlet efter provokationstestet upplevde att livet var mindre begränsat jämfört med innan provokationen. Alla återintroducerade inte det testade livsmedlet trots en negativ provokation, vilket styrker vikten av uppföljning och utvärdering av födoämnesprovokationer.

Eosinophilic proctocolitis of infancy (dietary protein-induced proctocolitis of infancy) 320Eosinophilic enterocolitis of infancy (dietary protein-induced enterocolitis of infancy) 321Eosinophilic gastroenteropathies in the older child 322Eosinophilic oesophagitis 323Features suggestive of food allergy as a cause of gastrointestinal disease 323This chapter discusses the wide spectrum of eosinophilic (allergic) disorders of the gut. They are generally not IgE mediated. Presentation is with the full spectrum of gastrointestinal symptoms and signs. Outside infancy the disorders may only become apparent on investigation of chronic gut symptoms by endoscopy to exclude oesophagitis, peptic ulceration, enteropathy, or colitis. Important disorders to consider are: ...

Hypoglycemia is a frequent and often overlooked symptom. Indeed, most cases are related to insulin therapy in diabetic patients, to hormone deficiencies, or to very prolonged fasts. In other cases, however, unusual findings (unexplained hypoglycemia, especially if clinically severe, recurrent, postprandial, or in typical relationship to external factors such as food ingestion or exercise, or associated with hepatomegaly) should lead to a careful clinical and biological evaluation. Hyperinsulinemic hypoglycemia is a dysregulation of the glucose-induced insulin secretion. Besides insulinoma and genetic defects of the pancreatic ß-cell (congenital hyperinsulinism, CHI), some other pathophysiological mechanisms can lead to hypoglycemia with biological evidence for an involvement of the insulin signaling pathway (insulin-like substances, autoimmunity, and other).

Nausea is an unpleasant sensation of being about to vomit, can occur alone or can accompany vomiting, dyspepsia, or other gastrointestinal symptoms. It is common symptoms in patients receiving palliative care and is associated with substantial physical and psychological distress and worsening of quality of life. In cancer patients, cancer treatments and opioids are the most common causes. Management include supportive measures such as maintaining proper oral hygiene, frequent small volume food and fluid intake at regular intervals, intravenous fluids if appropriate, and discontinuation of unnecessary medications. Specific treatment should target the underlying cause, e.g., aggressive bowel regimen for opioid related constipation, and 5HT3 receptor antagonists for chemotherapy induced nausea.

The ‘‘neuroleptic’’ antipsychotic group of pharmacologic agents was so named because the original agents, now called ‘‘conventional’’ antipsychotics, produced significant neurologic side effects in the form of extrapyramidal symptoms (EPS). However, neuroleptics were the first drugs to be effective in treating psychosis and remain the cornerstone of pharmacologic management of psychotic symptoms, whether such symptoms are primary or arise in the context of neurologic disorders. Although the only U.S. Food and Drug Administration (FDA)–approved use of antipsychotic agents is for the treatment of schizophrenia, mania, and ‘‘psychosis,’’ there is strong agreement among dementia experts that both the conventional antipsychotics and the newer ‘‘atypical’’ agents have a place in the management of several behavioral symptoms in persons with dementia (Small et al., 1997). Concerns have been raised regarding increased risk of stroke and increased mortality in the elderly, and a recent meta-analysis found the use of both conventional and atypical antipsychotics in dementia to be associated with a small increased risk for death compared with placebo (Schneider, Dagerman, and Insel, 2005). When choosing an antipsychotic medication, these and other risks should be considered within the context of an individual patient’s medical need for the drug, medical comorbidity, and the efficacy and safety of alternatives. In psychiatric disorders complicating neurologic diseases, antipsychotic drugs are used to treat specific syndromes (mania, delusional depression, schizophrenia) and target symptoms (hallucinations, delusions, tics in Tourette’s syndrome, chorea in Huntington’s disease). They are also used to ameliorate severe agitation or other behavioral problems that threaten the safety of the patient or others and have not responded to alternative interventions. These indications for antipsychotic drug use are further detailed in the chapters on specific neurologic diseases. Antipsychotic medications should not be used for milder behavioral disturbances, such as the wandering, disinhibited social intrusiveness, or frustration-induced emotional lability seen in some patients with cognitive impairment. In these instances, nonpharmacologic methods such as environmental manipulation should be tried first. For example, gentle redirection of the patient, assistance with activities of daily living, a night light in the bedroom, structured schedules of activities, and caregiver education about such strategies may alleviate some problem behaviors.

Disaccharidases are abundant enzymes expressed on the microvillous membrane of the small intestine: apart from free glucose and fructose, disaccharidases are required for the complete assimilation of nearly all carbohydrate present in food and drinks. The enzymes cleave disaccharides such as sucrose, maltose, and lactose, as well as dextrins derived from starch, into their component monosaccharides. Their activity is reduced in hereditary conditions or in generalized intestinal diseases. Disaccharidase deficiency causes dietary intolerance of carbohydrate induced by the fermentation of undigested sugars in the distal small intestine and colon. Abdominal symptoms are usually noticed within an hour of the ingestion of foods containing the offending sugars. By far the most common symptomatic disaccharidase deficiency is lactose intolerance. Lactase activity is high in healthy infants when milk is the principal food, but in most humans the activity declines after weaning and remains low (lactase nonpersistence), which greatly reduces the capacity to break down lactose. In contrast, those inheriting a Mendelian dominant trait that leads to sustained high intestinal lactase expression throughout life (lactase persistence) digest and tolerate large quantities. The distribution of lactase activity in adult populations is subject to great variation. Intestinal lactase phenotypes can be identified by assay of mucosal biopsy samples or appropriate sugar tolerance tests, as can other (much rarer) genetically determined disaccharidase variants. The most convenient diagnostic screen involves hydrogen breath testing after oral loading. Disaccharide intolerance is readily treated by institution of a strict exclusion diet; oral enzymatic supplementation may benefit patients with severe enzymatic deficiency. Innovative and early phase clinical trials suggest that modulation of the host intestinal microbiome with a pure short-chain galacto-oligosaccharide may be beneficial in symptom control and in favouring the outgrowth of lactose-fermenting flora.

An abundance of diet therapies are proposed to treat chronic intestinal disorders such as the irritable bowel syndrome (IBS) and eosinophilic esophagitis (EoE). These commonly either eliminate or restrict specific foods and/or food components, based on the principle that even trace amounts induce an immune reaction (e.g., elimination diets for EoE), or, in the case of restrictive diets, that individuals have a threshold level of tolerance below which symptom control will be induced. The low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet for IBS is one example of a restrictive diet based on sound rationale, robust efficacy data, comprehensive food composition information that is publicly available in a user-friendly form, and, increasingly, longitudinal data to demonstrate the long-term benefits. To optimize patient outcomes, health care professionals must be aware of the risks, benefits, and clinical indications for the use of diet therapies proposed to treat chronic intestinal disorders.