食品敏感性過(guò)敏性反應(yīng)和食品不耐性

1、lEmployees should be aware of major allergens and the menu items that contain them.lWhen serving customers with food allergies, servers must be ready to answer customers questions about any menu item. lServers should never take a guess about what a menu item contains. If they dont know, they should

2、ask someone who does.lCross-contact occurs when allergens are transferred from food containing an allergen to the food served to the customer.2A food allergy is the bodys negative reaction to a food protein.lDEFINITION AND MECHANISMS OF ADVERSE FOOD REACTION第一節(jié) 食品不良反應(yīng)的定義和機(jī)理lSYMPTOMS OF ADVERSE FOOD

3、REACTIONS第二節(jié) 食品不良反應(yīng)的癥狀lDIAGNOSIS OF ADVERSE FOOD REACTIONS第三節(jié) 食品不良反應(yīng)的診斷法lPREVALENCE第四節(jié) 發(fā)病率lFOOD ALLERGENS第五節(jié) 食品過(guò)敏原lFOOD ADDITIVES第六節(jié) 食品添加劑lFOOD LABELING IN RELATION TO FOOD SENSITIVITIES 第七節(jié) 與食品過(guò)敏性有關(guān)的食品標(biāo)簽6l食物過(guò)敏和食物不耐受都是機(jī)體對(duì)食物食物過(guò)敏和食物不耐受都是機(jī)體對(duì)食物的不良反應(yīng)過(guò)程；的不良反應(yīng)過(guò)程；l食物過(guò)敏是由所攝入的食物或食物成分食物過(guò)敏是由所攝入的食物或食物成分所引發(fā)的一種所引發(fā)

4、的一種免疫反應(yīng)免疫反應(yīng)；與食物或食物；與食物或食物成分的生理學(xué)作用無(wú)關(guān)；成分的生理學(xué)作用無(wú)關(guān)；l食物不耐受是由食物或食物成分所引發(fā)食物不耐受是由食物或食物成分所引發(fā)的機(jī)體的一種異常生理反應(yīng)，與機(jī)體免的機(jī)體的一種異常生理反應(yīng)，與機(jī)體免疫反應(yīng)無(wú)關(guān)。疫反應(yīng)無(wú)關(guān)。Fig.1 Classification of foods proposed by EAACI圖1 EAACI對(duì)食品的分級(jí)lA classical toxic food reaction is scombroid fish poisoning, due to large amounts of histamine 鯖亞目魚(yú)組胺中毒是典型的食品毒

5、性反應(yīng)。 lenzymatic (resulting from an enzymatic defect, e.g., lactase deficiency), “ 酶促性的”（因酶缺陷造成，如乳糖酶缺乏癥） lpharmacological (depending on the direct effect of, e.g., vaso-active amines naturally found in foods) “藥理學(xué)的”（取決于直接效應(yīng)，如食品中天然存在的血管活性胺）l“Undefined不明確的”10l超敏反應(yīng)（超敏反應(yīng)（hypersensitivityhypersensitivity）

6、可以客觀再現(xiàn)的癥狀或體征；可以客觀再現(xiàn)的癥狀或體征；接觸一定量的刺激物而誘發(fā)；接觸一定量的刺激物而誘發(fā)；正常人可以耐受。正常人可以耐受。l過(guò)敏（過(guò)敏（allergyallergy）由免疫機(jī)制介導(dǎo)的超敏反應(yīng)；由免疫機(jī)制介導(dǎo)的超敏反應(yīng)；是對(duì)一些食物中的無(wú)害蛋白（牛奶蛋白）、是對(duì)一些食物中的無(wú)害蛋白（牛奶蛋白）、花粉、頭皮屑、寵物、屋塵螨的過(guò)度免疫花粉、頭皮屑、寵物、屋塵螨的過(guò)度免疫反應(yīng)反應(yīng)11l特應(yīng)性反應(yīng)（特應(yīng)性反應(yīng)（atopyatopy）具有家庭遺傳傾向，對(duì)于小劑量的過(guò)敏原能具有家庭遺傳傾向，對(duì)于小劑量的過(guò)敏原能產(chǎn)生大量的產(chǎn)生大量的IgEIgE抗體；抗體； 發(fā)展為過(guò)敏癥的可能性增加發(fā)展為過(guò)敏癥的

7、可能性增加1213l食物過(guò)敏是指?jìng)€(gè)體在攝入某種食物之后，食物過(guò)敏是指?jìng)€(gè)體在攝入某種食物之后，由機(jī)體免疫機(jī)制調(diào)節(jié)所引發(fā)的不良反應(yīng)，由機(jī)體免疫機(jī)制調(diào)節(jié)所引發(fā)的不良反應(yīng)，并且引起靶器官功能的改變，如皮膚、并且引起靶器官功能的改變，如皮膚、胃腸道、呼吸道以及心血管系統(tǒng)等。胃腸道、呼吸道以及心血管系統(tǒng)等。14l過(guò)敏歷程過(guò)敏歷程食物過(guò)敏食物過(guò)敏 螨蟲(chóng)螨蟲(chóng) 花粉過(guò)敏花粉過(guò)敏濕疹濕疹 消化道過(guò)敏癥消化道過(guò)敏癥 喘息喘息 鼻炎鼻炎 、過(guò)、過(guò)敏性哮喘、慢性特應(yīng)性皮炎（濕疹）敏性哮喘、慢性特應(yīng)性皮炎（濕疹）l惡性循環(huán)惡性循環(huán)一種過(guò)敏原一種過(guò)敏原 多種過(guò)敏原多種過(guò)敏原累及一個(gè)組織累及一個(gè)組織/ /器官器官 累及多個(gè)組

8、織累及多個(gè)組織/ /器官器官15l目前尚無(wú)確切的食物過(guò)敏流行病學(xué)數(shù)據(jù)，目前尚無(wú)確切的食物過(guò)敏流行病學(xué)數(shù)據(jù)，呈增加趨勢(shì)；呈增加趨勢(shì)；l8%8%的兒童和的兒童和2%4%2%4%的成人可能受食物的成人可能受食物過(guò)敏的影響；過(guò)敏的影響；l絕大多數(shù)食物過(guò)敏癥狀發(fā)生在絕大多數(shù)食物過(guò)敏癥狀發(fā)生在1 1歲之內(nèi)；歲之內(nèi)；l有家族遺傳過(guò)敏性疾病的個(gè)體中發(fā)生率有家族遺傳過(guò)敏性疾病的個(gè)體中發(fā)生率高。高。16lIgEIgE依賴型食物過(guò)敏：即依賴型食物過(guò)敏：即I I 型變態(tài)反應(yīng)，型變態(tài)反應(yīng)，有肥大細(xì)胞和有肥大細(xì)胞和IgEIgE參與反應(yīng)，呈速發(fā)反應(yīng)，參與反應(yīng)，呈速發(fā)反應(yīng)，臨床表現(xiàn)為鼻炎、哮喘、濕疹、蕁麻疹臨床表現(xiàn)為鼻炎、哮

9、喘、濕疹、蕁麻疹等；等；lIgEIgE非依賴型食物過(guò)敏：包括非依賴型食物過(guò)敏：包括型、型、 型型和和型型17l最主要的類型；最主要的類型；l致敏階段：食物過(guò)敏原刺激特異性致敏階段：食物過(guò)敏原刺激特異性IgEIgE產(chǎn)生，并結(jié)產(chǎn)生，并結(jié)合于肥大細(xì)胞、嗜堿性粒細(xì)胞、單核細(xì)胞、巨噬合于肥大細(xì)胞、嗜堿性粒細(xì)胞、單核細(xì)胞、巨噬細(xì)胞等表面；細(xì)胞等表面；l激發(fā)階段：當(dāng)再次暴露于食物抗原時(shí)，抗原與激發(fā)階段：當(dāng)再次暴露于食物抗原時(shí)，抗原與IgEIgE結(jié)合，刺激細(xì)胞釋放組胺、前列腺素、白介素等結(jié)合，刺激細(xì)胞釋放組胺、前列腺素、白介素等介質(zhì)釋放；介質(zhì)釋放；l這些介質(zhì)會(huì)引發(fā)血管舒張、平滑肌收縮、以及粘這些介質(zhì)會(huì)引發(fā)血管

10、舒張、平滑肌收縮、以及粘液釋放液釋放-即速發(fā)型過(guò)敏反應(yīng)；即速發(fā)型過(guò)敏反應(yīng)；l此外，活化的肥大細(xì)胞還可以釋放一些細(xì)胞因子，此外，活化的肥大細(xì)胞還可以釋放一些細(xì)胞因子，這些細(xì)胞因子參與這些細(xì)胞因子參與IgEIgE調(diào)節(jié)的遲發(fā)過(guò)敏反應(yīng)。調(diào)節(jié)的遲發(fā)過(guò)敏反應(yīng)。20IgEl研究較少；研究較少；l型變態(tài)反應(yīng)（抗原抗體復(fù)合物調(diào)型變態(tài)反應(yīng)（抗原抗體復(fù)合物調(diào)節(jié)）：若食物抗原在體液中與特異性抗節(jié)）：若食物抗原在體液中與特異性抗體結(jié)合形成復(fù)合物，它們將被血管濾膜體結(jié)合形成復(fù)合物，它們將被血管濾膜組織（如腎小球）截獲，沉積，激活補(bǔ)組織（如腎小球）截獲，沉積，激活補(bǔ)體，導(dǎo)致血管組織受害；體，導(dǎo)致血管組織受害；l型變態(tài)反應(yīng)（

11、細(xì)胞調(diào)節(jié)）：型變態(tài)反應(yīng)（細(xì)胞調(diào)節(jié)）：T T細(xì)胞識(shí)別細(xì)胞識(shí)別特異性抗原，通過(guò)細(xì)胞免疫途徑，造成特異性抗原，通過(guò)細(xì)胞免疫途徑，造成臨近宿主細(xì)胞的破壞，癥狀一般在攝入臨近宿主細(xì)胞的破壞，癥狀一般在攝入抗原食物之后幾小時(shí)出現(xiàn)?？乖澄镏髱仔r(shí)出現(xiàn)。 21l病理作用：抗寄生蟲(chóng)作病理作用：抗寄生蟲(chóng)作用；用；l現(xiàn)代生活中寄生蟲(chóng)感染現(xiàn)代生活中寄生蟲(chóng)感染幾乎銷聲匿跡幾乎銷聲匿跡 IgEIgE的作用何在：的作用何在： 儲(chǔ)備；儲(chǔ)備； 致病致病 l為維系胎兒的生存，避免為維系胎兒的生存，避免母胎之間的排斥，胎兒期母胎之間的排斥，胎兒期Th1Th1應(yīng)答低下；應(yīng)答低下；l生后維持生后維持Th2Th2傾向；傾向；lTh2

12、Th2應(yīng)答傾向是過(guò)敏性疾病應(yīng)答傾向是過(guò)敏性疾病的免疫學(xué)基礎(chǔ)。的免疫學(xué)基礎(chǔ)。人類的進(jìn)化似乎給現(xiàn)代人類的人類的進(jìn)化似乎給現(xiàn)代人類的健康設(shè)下了陷阱健康設(shè)下了陷阱 之二：與生懼來(lái)的之二：與生懼來(lái)的Th2Th2傾向傾向食物過(guò)敏的發(fā)病機(jī)制食物過(guò)敏的發(fā)病機(jī)制l - -兩大陷阱的作用兩大陷阱的作用22Th1Th2參與抗感染過(guò)程，殺參與抗感染過(guò)程，殺死被細(xì)菌、病毒感染死被細(xì)菌、病毒感染的細(xì)胞和腫瘤細(xì)胞，的細(xì)胞和腫瘤細(xì)胞，抑制抑制B B細(xì)胞產(chǎn)生細(xì)胞產(chǎn)生IgEIgE使炎癥細(xì)胞釋放組使炎癥細(xì)胞釋放組胺，使胺，使B B細(xì)胞產(chǎn)生細(xì)胞產(chǎn)生IgEIgE，引起過(guò)敏反應(yīng)，引起過(guò)敏反應(yīng)調(diào)節(jié)性調(diào)節(jié)性T T淋巴淋巴細(xì)胞細(xì)胞23Th1T

13、h2改善過(guò)敏改善過(guò)敏過(guò)敏持續(xù)過(guò)敏持續(xù)Th1Th1Th2Th2兒童兒童成人成人嬰兒嬰兒2425l目的：解釋不斷增加的過(guò)敏性并的發(fā)病率；目的：解釋不斷增加的過(guò)敏性并的發(fā)病率；l19891989年，流行病學(xué)專家年，流行病學(xué)專家Dr StrachanDr Strachan提出來(lái)的；提出來(lái)的；l家庭規(guī)模與過(guò)敏呈負(fù)相關(guān)；家庭規(guī)模與過(guò)敏呈負(fù)相關(guān)；l同一家庭中年幼兒比年長(zhǎng)兒過(guò)敏的發(fā)生率高同一家庭中年幼兒比年長(zhǎng)兒過(guò)敏的發(fā)生率高l提出兒童早期感染減少，接觸同胞機(jī)會(huì)減少提出兒童早期感染減少，接觸同胞機(jī)會(huì)減少是過(guò)敏性疾病升高的原因；是過(guò)敏性疾病升高的原因；l微生物接觸有助于刺激微生物接觸有助于刺激Th1Th1的增強(qiáng)的

14、增強(qiáng)Clinical manifestations of IgE-mediated food allergy can remain localized at the site of the primary direct contact, i.e., 一直保持在最初的直接接觸部位 the mouth 嘴throat (oral allergy syndrome)咽喉（口腔敏感綜合癥）the gastroiniesrinal tract (isolated gastrointestinal food allergy)胃腸道（單獨(dú)的胃腸道食品敏感癥） Skin Respiratory tract G

15、I tract Cardievascular S.皮膚 呼吸道 胃腸道 心臟血管系統(tǒng)45% 25% 20% 10%Figure 2 Classical symptoms of IgE-mediated food ailergy圖2 以IgE為媒介的食品敏感綜合癥分布lAllergen: fresh foods( fruits and vegetables) 過(guò)敏原：過(guò)敏原：新鮮食品（如水果和蔬菜）lSymptom 癥狀：癥狀：Itching of the lips, mouth, palate， throat 嘴唇、嘴、上腭咽喉等處立即發(fā)癢Hoarseness and/or swelling

16、of the lips, tongue, uvula, and larynx 嗓音嘶啞，嘴唇、舌頭、小舌、喉等腫脹lSymptom 癥狀：癥狀：1）The main symptoms of gastrointestinal food allergy are vomiting, nausea, diarrhea, and abdominal pains (colics or cramps).胃腸道主要癥狀:嘔吐、反胃、腹瀉以及腹部疼痛（絞痛或痛性痙攣）；2) Skin reactions include local or generalized pruritus, flush, urticari

17、a, angioedema. morbilliform exanthema, and flare-up of atopic dermatitis 皮膚反應(yīng)：局部的或無(wú)顯著特點(diǎn)的搔癢癥、面部潮紅、風(fēng)疹、血管性水腫、麻疹樣疹病、突發(fā)特異性皮炎；3) The symptoms of the upper and the lower respiratory tract are rhinitis (sneezing, pruritus of the nose, nasal stuffiness, and nasal obstruction), larynx edema, cough, wheezing,

18、and bronchial asthma. 上呼吸道或稍低些的呼吸道癥狀： 鼻炎（打噴嚏、鼻搔癢癥、鼻子不通氣、鼻塞）、喉腫、咳嗽、喘息以及支氣管哮喘；4) Itching, redness, and watering eyes (conjunctivitis) 發(fā)癢、充血以及眼睛流淚（結(jié)膜炎）.lSymptom 癥狀：癥狀：respiratory symptoms 呼吸道綜合癥 lAllergen: flour, n-amylase, green coffee, castor and soy beans, spices. egg white, and crustaceans 過(guò)敏原：過(guò)敏原：

19、面粉、-淀粉酶、綠咖啡、海貍香和大豆、調(diào)味品、雞蛋白以及甲殼動(dòng)物 lAllergen: fish, shrimp, flour, and pork 過(guò)敏原：過(guò)敏原：魚(yú)、小蝦、面粉和豬肉 lSymptom 癥狀：癥狀： Urticarial lesion 風(fēng)疹lChronic contact with a food may induce protein contact, dermatitis in food handlers 食品操作工人長(zhǎng)期接觸某種食品會(huì)誘導(dǎo)蛋白接觸性皮炎。 DEFINITIONDEFINITION：The term Heiners syndrome characterizes

20、 a milk-induced syndrome with pulmonary disease in infants. Heiner綜合癥：嬰兒因牛奶誘導(dǎo)的肺病 lSymptom 癥狀：癥狀：chronic or recurrent pulmonary intiltrates chronic or recurrent pulmonary intiltrates 慢性或慢性或周期性發(fā)生的肺滲透周期性發(fā)生的肺滲透allergic alveolitis allergic alveolitis 過(guò)敏性齒槽炎過(guò)敏性齒槽炎a chronic rhinitis a chronic rhinitis 慢性鼻炎

21、慢性鼻炎gastrointestinal blood loss gastrointestinal blood loss 腸胃失血癥腸胃失血癥iron deficiency anemia iron deficiency anemia 缺鐵性貧血缺鐵性貧血chronic cough chronic cough 慢性咳嗽慢性咳嗽recurrent fever recurrent fever 周期性發(fā)燒周期性發(fā)燒Anorexia Anorexia 厭食厭食Vomiting Vomiting 嘔吐嘔吐Colic Colic 絞痛絞痛Diarrhea Diarrhea 腹瀉腹瀉Hemoptysis Hem

22、optysis 咳血咳血lControl 控制措施：控制措施：linstitution of a milk-free diet飲食中去除牛奶lDefinitionDefinition：damage to the small intestinal mucosa and symptoms of malabsorption定義：定義：小腸黏膜損傷和吸收不良癥狀小腸黏膜損傷和吸收不良癥狀 lAllergen Allergen 過(guò)敏原：過(guò)敏原：Gliadin Gliadin 麥醇溶蛋白麥醇溶蛋白present in wheat, rye, barley, and oat present in wheat

23、, rye, barley, and oat 廣泛存在于小麥、燕麥、大麥和黑麥中廣泛存在于小麥、燕麥、大麥和黑麥中 The peak incidence of symptoms is in infancy after the introduction of cereals; 嬰兒開(kāi)始添加谷物類食物時(shí)最容易發(fā)生這類癥狀，為第一高峰期；A second peak occurs during the third decade. 第二高峰期發(fā)生在三十歲。lSymptom 癥狀：癥狀：labdominal pain周期性腹部疼痛lloose stools便溏lanorexia厭食lshort statu

24、re體態(tài)短小ldelayed puberty青春期滯緩lnutritional deficiencies吸收不良lDental enamel hypoplasia 牙科瓷發(fā)育不全lrecurrent aphthae周期性口瘡 lControl 控制措施：控制措施：Patients with celiac disease must avoid gliadins and related proteins permanently遠(yuǎn)離麥醇溶蛋白以及相關(guān)蛋白質(zhì)lDefinition 定義： chronic blistering disease 一種慢性起皰疾病 l Symptom 癥狀：癥狀：litch

25、y 發(fā)癢lsometimes burning 有時(shí)有灼傷感l(wèi)eruption of grouped vesicles on an erythematous ground 在紅斑狀范圍內(nèi)出現(xiàn)成群泡樣出疹 lSome DH patients, even without gastrointestinal symptoms, may have villous atrophy similar to that seen in celiac disease有些DH病人甚至在沒(méi)有出現(xiàn)胃腸道綜合癥的情況下，也會(huì)出現(xiàn)與乳糜瀉類似的絨毛狀萎縮癥，也就是說(shuō)DH與CD之間有關(guān)連。lThe cutaneous manif

26、estations may or may not respond to a gluten-free diet飲食中排除麥醇溶蛋白可能會(huì)、也有可能不會(huì)改善皮膚癥狀。lDefinition Definition 定義：定義：elevated eosinophil counts in blood and tissue eosinophilia with release of eosinophii major basic protein 釋放嗜曙紅細(xì)胞主要基本蛋白質(zhì)后，血液中嗜曙紅細(xì)胞和嗜曙紅血球增多的間質(zhì)組織內(nèi)嗜曙紅細(xì)胞計(jì)數(shù)值升高 l Clinical manifestations 臨床癥狀：臨床癥

27、狀：l vomiting 嘔吐labdominal pain 腹部疼痛lDiarrhea 腹瀉l malabsorption 吸收不良lbowel obstruction 腸阻塞lAscites 腹水lThe cause of EG is unknown 起因還不清楚lfood hypersensitivity has been suggested EG可能由食品超敏性引起lDefinition 定義： an inflammatory bowel disease of unknown origin 一種不明起因的炎癥性腸病 lNo adverse food reactions have bee

28、n shown as causative of UC 還不能證明食品不良反應(yīng)會(huì)造成UC lCause Cause 起因：起因：foods and food additives 食品及其添加劑lSymptom Symptom 癥狀：癥狀：allergic purpura (widespread hemorrhagic macules and papules, mainly on the lower legs) demonstrated by single challenges變應(yīng)性紫癜（分布廣泛的出血性斑丘疹，主要出現(xiàn)在腿的下部） lDefinition 定義：定義：Lack of the en

29、zyme that cleaves milk sugar, lactose, gives rise to adverse reactions when lactose is consumed.當(dāng)攝入乳糖時(shí)，由于體內(nèi)缺乏一種能將牛奶糖質(zhì)-乳糖水解的酶，從而產(chǎn)生不良反應(yīng) lThe only food of which lactose is a natural constituent is milk (3.7 g/100 ml cows milk). 天 然 含 乳 糖 的 唯 一 食 品 是 牛 奶（3.7g/ml牛奶）lClassification 分類：分類：1） congenital lac

30、tase deficiency先天性乳糖酶缺乏綜合征2） primary lactase deficiency初級(jí)的乳糖酶缺乏綜合征3） secondary lactase deficiency二級(jí)乳糖酶缺乏綜合征 1） congenital lactase deficiency先天性乳糖酶缺乏綜合征lactase is not present and symptoms will appear when the patient is breast-fed. 人體內(nèi)不存在乳糖酶，當(dāng)進(jìn)行人乳哺育時(shí)會(huì)出現(xiàn)綜合征The congenital form is very rare 這種癥狀極少見(jiàn)2） pr

31、imary lactase deficiency初級(jí)的乳糖酶缺乏綜合征seen in most of the worlds population where the production of lactase decreases or disappears from the age of 2 to the teenage years在2-10歲時(shí)，乳糖酶分泌下降或消失l Persistent high lactase activity in adult life occurs among relatively few ethnic groups:成年人體內(nèi)乳糖酶活性一直處于高峰的人群： lno

32、rthern Europeans and their overseas descendants北歐以及沿海后代la few African groups of pastoral tradition Bedouins and other Saudi Arabs一些源于牧人的非洲人、貝都因人和沙特阿拉伯人l certain groups from west India and Pakistan西印度和巴基斯坦部分人群l3） secondary lactase deficiency二級(jí)乳糖二級(jí)乳糖酶缺乏綜合征酶缺乏綜合征a consequence of pathological changes in

33、 the gut mucosa, as seen in celiac disease or inflammations. 乳糜瀉或炎癥引起內(nèi)臟黏膜病變的結(jié)果 When the gut mucosa has regained its normal appearance the lactase production reappears 當(dāng)內(nèi)臟黏膜恢復(fù)正常，乳糖酶也開(kāi)始重新分泌。 lThe symptoms The symptoms 癥狀：癥狀：Diarrhea 腹瀉gas production 產(chǎn)氣Colic 絞痛lControl 控制措施：avoid all products containin

34、g even small amounts of lactose 避免食用任何含乳糖的食品 lThe total prevalence of food allergy/food intolerance is not known. 總發(fā)病率未知lEstimates based on data from one country do not necessarily reflect the prevalence of another country 在某個(gè)國(guó)家統(tǒng)計(jì)得到的數(shù)據(jù)并不能用到另一個(gè)國(guó)家，因?yàn)椋?） frequency and duration of breast feeding 母乳喂養(yǎng)的頻率

35、和持續(xù)時(shí)間2）eating habits飲食習(xí)慣3） flora植物群lallergy to cows milk, egg, and fish predominantly begins before the second year of age 對(duì)牛奶、雞蛋和魚(yú)的過(guò)敏性主要發(fā)生2歲以前l(fā)allergy to fruit, legumes, and vegetables predominantly begins after the second year. 對(duì)水果、豆類和蔬菜的過(guò)敏性主要發(fā)生在2歲以后 lTable 1 Prevalence of Rhinitis and Oral Itch i

36、n Danish School Children 丹麥學(xué)齡兒童中鼻炎和口腔發(fā)癢的發(fā)病率丹麥學(xué)齡兒童中鼻炎和口腔發(fā)癢的發(fā)病率 Age (yr) Rhinitis (%) boys/girlsOral itch（%) boys/girls5-79.0/5.70/0.38-108.5/7.10.8/1.111-1314.0/8-51.9/1.514-1617.3/13.02.9/2.0lAdverse reactions to food additives are found in 1-2% of school children 1-2%學(xué)齡兒童對(duì)食品添加劑有不良反應(yīng)lThe prevalence

37、in younger children is not known. 至今不知小年齡兒童的發(fā)病率 lIn European studies the majority of allergic food reactions in adults are caused by fruits. vegetables, and nuts and are related to pollen allergy 在歐洲，大部分成年人食品過(guò)敏性反應(yīng)是由水果、蔬菜和堅(jiān)果引起的，且與花粉過(guò)敏癥有關(guān)lThe prevalence is around 5% 發(fā)病率在5%左右lprobably only 0,5% have sy

38、mptoms other than oral itch. 大約只有0.5%不是口腔發(fā)癢癥狀lThe prevalence of allergy to milk, egg, fish. etc. is around 0.2%，牛奶、雞蛋、魚(yú)等引起的過(guò)敏癥發(fā)病率大約為0.2% lThe estimated frequency was 0.03-0.15% 1982年EEC理論計(jì)算值：食品添加劑引起的發(fā)病率為0.03-0.15% lIn British ：theprevalence 大不列顛人 ：發(fā)病率為0.026% lDutch 丹麥 ：0.4%l10 % Danish women have co

39、ntact allergy caused by nickel. 10%丹麥婦女因鎳造成接觸性過(guò)敏癥lUp to 10% of these may benefit from a nickel-restricted diet 其中10%以上會(huì)因排除鎳的飲食而改善lWhat is contact allergensWhat is contact allergens？In dermally sensitized subjects ingestion of the contact allergen may cause skin flare reactions or other symptoms, e.g

40、., in the gastroinlestinal tract 皮膚敏感癥受檢者攝入接觸性過(guò)敏原后會(huì)導(dǎo)致皮膚潮間帶反應(yīng)或胃腸道癥狀等其他癥狀。 lContact AllergensContact Allergens：fragrances 芳香物質(zhì)food flavors（natural or synthetic）食品風(fēng)味物Nickel 鎳 1）Celiac disease腹部疾?。篊ause：wheat gliadin and related proteins起因：小麥麥醇溶蛋白和相關(guān)蛋白質(zhì)The prevalence ： 0.2-0.5%發(fā)病率：0.2-0.5% 2） lactase de

41、ficiency 乳糖酶缺乏綜合征乳糖酶缺乏綜合征Cause：Lack of lactase起因：缺乏乳糖酶起因：缺乏乳糖酶 The prevalence ： varies from a few percent in northern European countries to almost the entire adult population in Asia and Africa 發(fā)病率：發(fā)病率：從北歐國(guó)家到亞洲和非洲國(guó)家，從北歐國(guó)家到亞洲和非洲國(guó)家，成年人發(fā)病率相差好幾個(gè)百分點(diǎn)成年人發(fā)病率相差好幾個(gè)百分點(diǎn) Conclusion：It is not known whether the pr

42、evalence of food allergy or intolerance is increasing 不清楚食品過(guò)敏/不耐性的發(fā)病率是否有上升趨勢(shì) The prevalence of pollen-related food allergies has increased. 與花粉相關(guān)食品敏感癥的發(fā)病率在提高。lAllergens are antigens that give rise to allergy . 過(guò)敏原是能引起敏感的抗原 Foreign, non-self substances 外來(lái)的，非自身物質(zhì)；外來(lái)的，非自身物質(zhì)；lPollen花粉lMammals哺乳動(dòng)物l mites

43、螨lother insects其他昆蟲(chóng)l foods食品lComponent：過(guò)敏原成分：過(guò)敏原成分： Proteins or glycoproteins with a molecular weight from 3 to 90 kDa, the majority ranging from 10 to 40 kDa 已知結(jié)構(gòu)的過(guò)敏原都是蛋白質(zhì)或糖蛋白，分子量從3kDa到90kDa，大部分在10kDa到40kDa之間All protein are potent allergens, especially those response to Th2 protein.任何蛋白質(zhì)都是潛在的過(guò)敏原，尤其

44、是那些容易導(dǎo)致任何蛋白質(zhì)都是潛在的過(guò)敏原，尤其是那些容易導(dǎo)致Th2Th2應(yīng)答的蛋白質(zhì)。應(yīng)答的蛋白質(zhì)。lthe first three letters of the genus, space, the first letter of the species, space, and an Arabic number. l XXX X X 屬 種 阿拉伯?dāng)?shù)字lFor example： Lol p 1 refers to the first pollen allergen identified from Lolium perennc, or rye grass Lol p 1表示第一個(gè)花粉過(guò)敏原，來(lái)自

45、Lolium perenne 或黑麥草 majormajor： proteins for which 50% or more of the allergic patients studied have specific IgE“主要的”：能使50%或以上被研究病人具有特異性IgE的蛋白質(zhì)minorminor“：the remaining allergens are considered minor“次要的”：能使50%以下的被研究病人具有特異性IgE的蛋白質(zhì)92含有過(guò)敏原結(jié)構(gòu)含有過(guò)敏原結(jié)構(gòu)外源性蛋白或糖蛋白，高度有序的結(jié)構(gòu)；外源性蛋白或糖蛋白，高度有序的結(jié)構(gòu)；食物中含有一定的量（牛奶、雞蛋、魚(yú)

46、、食物中含有一定的量（牛奶、雞蛋、魚(yú)、花生等）；花生等）；穩(wěn)定、食物加工過(guò)程中不受破壞；穩(wěn)定、食物加工過(guò)程中不受破壞；抵抗胃腸道的消化抵抗胃腸道的消化93食食 物物 類類 別別食食 物物 舉舉 例例富含蛋白質(zhì)的食物 海產(chǎn)類 有特殊氣味的食物 有特殊刺激性的食物 某些生食的食物 某些富含細(xì)菌的食物 富含霉菌的食物富于蛋白質(zhì)而不易消化的食物種子類食物一些外來(lái)不常吃到的食物牛奶、雞蛋魚(yú)、蝦、蟹、海貝、海帶蔥、蒜、洋蔥、韭菜、香菜、羊肉辣椒、胡椒、酒、芥末、姜生番茄、生花生、生栗子、生核桃、桃、葡萄、柿子死的魚(yú)、蝦、蟹、不新鮮的肉類蘑菇、酒糟、米醋蛤蚌類、烏賊、魷魚(yú)各種豆類、花生、芝麻如一些外國(guó)進(jìn)口的

47、食物易引起過(guò)敏的食物易引起過(guò)敏的食物 lTo make a complete list of allergenic foods on a global basis is virtually impossible. 我們不可能列出一張食品過(guò)敏原清單lWhether a food allergen causes significant problems in a population is dependent on several factors：某種食品過(guò)敏原是否會(huì)在消費(fèi)者中引起明顯的問(wèn)題取決于以下幾個(gè)方面： l some are much more frequent sensitizers l

48、han others有些抗體比其他抗體造成敏感癥的次數(shù)更多，e.g., -lactoglobulin in milk or ovomucoid from egg white如：牛奶中的-乳球蛋白或雞蛋蛋白中的卵類粘蛋白1）The chemical structure, i.e., the amino acid sequence, and the tertiary structure 化學(xué)結(jié)構(gòu)如氨基酸序列，蛋白質(zhì)三級(jí)結(jié)構(gòu)2）heat stability 熱穩(wěn)定性3）digestibility 可消化性4）Structural relationship with epitopes from non

49、food allergens 非食品過(guò)敏原與抗原決定族之間的結(jié)構(gòu)關(guān)系lIn Europe allergy to rice and buckwheat is uncommon.在歐洲，稻米和蕎麥一般不引起敏感癥lIn Japan rice and buckwheat are common food allergens 在日本，稻米和蕎麥通常是食品過(guò)敏原。1）aero-allergens：grasses, pollen of trees and herbs ， house dust mites ，o cat dander 飛散過(guò)敏原：草、樹(shù)或藥草的花粉、屋塵螨、貓毛發(fā)皮屑 2）work envir

50、onment：baker工作環(huán)境：面包工人3）via the skin：Natural rubber (latex) 通過(guò)皮膚：天然橡膠1) local species of grass, trees, and herbs and pollution 當(dāng)?shù)厣L(zhǎng)的草、樹(shù)以及藥草種類e.g., Allergy to hazelnuts is common in areas with many birch trees, where birch pollen hay lever is frequent榛實(shí)敏感癥一般發(fā)生在有許多樺樹(shù)的地區(qū)，在這些地區(qū)經(jīng)常發(fā)生樺樹(shù)花粉熱2) air pollution空氣

51、污染lIn early infancy an increased uptake of antigen takes place at a time when the gut-associated lymphoid tissue is still incompletely developed 在幼年早期，在與消化道相關(guān)淋巴組織還沒(méi)有發(fā)育好的時(shí)候，抗原的攝入量相對(duì)較高。1）Albumin, -lactoglobulin, and immunoglobulins of milk are the most important allergens in infants嬰兒：清蛋白、-乳球蛋白和免疫球蛋白2

52、） In older children -lactoglobulin, caseins, and I-lactalbumin may be more reactive.大孩子：-乳球蛋白、酪蛋白和-乳白蛋白 3）in adulthood： casein to be the most frequent allergen 成人期：酪蛋白cross-reactions交叉反應(yīng)交叉反應(yīng)lThe majority of patients with allergy to cows milk proteins will also react to proteins from sheeps and goats

53、 milk 大部分對(duì)牛奶蛋白質(zhì)有敏感癥的病人同樣對(duì)綿羊奶和山羊奶有敏感癥 Cross-reactions between milk from these species is not always present.各種奶之間的交叉反應(yīng)并不一直存在 l the second most frequent food allergen in small children after cows milk 在小孩子中大概是僅次于牛奶的食品過(guò)敏原 lEgg white proteins are reported to elicit allergic reactions more frequently tha

54、n egg yolk. 雞蛋蛋白比蛋黃更易引起過(guò)敏反應(yīng)Protein蛋白質(zhì)蛋白質(zhì)Name分類名分類名molecular weight 分子量分子量(kDa)Content in egg white雞蛋白中的含量雞蛋白中的含量(%) Ovomucoid (*key)卵類粘蛋白卵類粘蛋白Gal d 1Gal d 12800011Ovalbumin 卵清蛋白卵清蛋白Gal d 2Gal d 245000450005454Ovotransferrin Ovotransferrin or conalbuminor conalbumin卵鐵傳遞蛋白或伴卵鐵傳遞蛋白或伴清蛋白清蛋白Gal d 3Gal d

55、3780007800012LysozymeLysozyme溶菌酶溶菌酶Gal d 4Gal d 4140003.4lcross-reactions交叉反應(yīng)交叉反應(yīng):l allergy to egg can be correlated to allergy to bird feathers 雞蛋敏感癥與鳥(niǎo)類羽毛敏感癥之間有相關(guān)性 lthe major cross-reacting determinants are the livetins from egg yolk. 主要交叉反應(yīng)的決定因素是蛋黃中的卵黃蛋白 lhazelnut 榛實(shí)lWalnut 胡桃lBrazil nut 巴西堅(jiān)果lAppl

56、e 蘋果lAlmond 杏仁lPeach 桃子lPlum 李子lCherry 櫻桃lPeanut 花生lPeas 豌豆lCarrot 胡蘿卜lparsley 歐芹lCelery 芹菜lOrange 橘子lStrawberry 草莓lCereals 谷物1）the age of the patients 病人的年齡2）the methods of diagnosis 診斷方法以及3）the geographic location of the population 地理環(huán)境l More than 90% of patients with sensitization to vegetable fo

57、ods had concomitant sensitization to pollen 90% 以上的蔬菜敏感癥總是伴隨著花粉敏感癥而來(lái) lIn a group of birch pollen allergies the patients with additional hypersensitivity to nuts and apples had：l 在一組同時(shí)有另外的堅(jiān)果和蘋果超敏性的樺樹(shù)花粉敏感癥病人中 l(1) more severe symptoms during the pollen seasonl 在花粉季節(jié)癥狀嚴(yán)重加重l(2) higher values of IgE to b

58、irch and hazel pollen,l 樺樹(shù)和榛子花粉的IgE值較高l(3) a larger area of the skin prick test reactive to birch and hazel pollen compared to the group without apple and nut allergy l 與那些沒(méi)有堅(jiān)果和蘋果超敏性病人相比，樺樹(shù)和榛子花粉的皮膚穿刺試驗(yàn)反應(yīng)區(qū)域要大得多。 lThe symptoms The symptoms 主要癥狀：主要癥狀：lMainly from the mouth and pharynx, with itching, sw

59、elling of the lips, tongue, and throat. syndrome. 從嘴到咽發(fā)癢，嘴唇、舌頭以及咽喉腫脹lThese symptoms are called the “oral allergy” “口腔敏感綜合癥” lcross-reactions交叉反應(yīng)交叉反應(yīng):1）A sensitization to mugwort pollens and different spices, the so-called mugwort-celery-spices syndrome, has been reported 艾蒿及其不同種艾屬植物的花粉有致敏性，又稱艾蒿-芹菜-香

60、料綜合癥。2） It was shown by prick, RAST studies, and RAST inhibition experiments 皮膚穿刺、RSAT研究以及RSAT抑制實(shí)驗(yàn)證明：a celery-thermolabile allergen seems to be involved in celery-birch-pollen-allergic patients 一種不耐熱芹菜過(guò)敏原會(huì)導(dǎo)致芹菜-樺樹(shù)-花粉敏感癥 a thermostable allergen is involved in celery -mug wort-allergic patients. 一種耐熱過(guò)敏