食品安全5

FoodSensitivities,AllergicReactions,andFoodIntolerances食品敏感性、过敏性反应和食品不耐性CONTENTS主要内容DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION第一节食品不良反应的定义和机理SYMPTOMSOFADVERSEFOODREACTIONS第二节食品不良反应的症状DIAGNOSISOFADVERSEFOODREACTIONS第三节食品不良反应的诊断法PREVALENCE第四节发病率FOODALLERGENS第五节食品过敏原FOODADDITIVES第六节食品添加剂FOODLABELINGINRELATIONTOFOODSENSITIVITIES第七节与食品过敏性有关的食品标签DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION第一节食品不良反应的定义和机理Fig.1ClassificationoffoodsproposedbyEAACI图1EAACI对食品的分级toxicfoodreactions食品毒性反应Aclassicaltoxicfoodreactionisscombroidfishpoisoning,duetolargeamountsofhistamine鲭亚目鱼组胺中毒是典型的食品毒性反应。Foodintolerance食品不耐性enzymatic(resultingfromanenzymaticdefect,e.g.,lactasedeficiency),“酶促性的”（因酶缺陷造成，如乳糖酶缺乏症）pharmacological(dependingonthedirecteffectof,e.g.,vaso-activeaminesnaturallyfoundinfoods)“药理学的”（取决于直接效应，如食品中天然存在的血管活性胺）“Undefined不明确的”SYMPTOMSOFADVERSEFOODREACTIONS第二节食品不良反应的症状IgE-MediatedFoodAllergy一、以IgE-为媒介的食品敏感症Characteristic特征ClinicalmanifestationsofIgE-mediatedfoodallergycanremainlocalizedatthesiteoftheprimarydirectcontact,i.e.,一直保持在最初的直接接触部位themouth嘴throat(oralallergysyndrome)咽喉（口腔敏感综合症）thegastroiniesrinaltract(isolatedgastrointestinalfoodallergy)胃肠道（单独的胃肠道食品敏感症）SkinRespiratorytractGItractCardievascularS.皮肤呼吸道胃肠道心脏血管系统45%25%20%10%Figure2ClassicalsymptomsofIgE-mediatedfoodailergy图2以IgE为媒介的食品敏感综合症分布OralAllergySyndrome（一）口腔敏感综合病症Allergen:freshfoods(fruitsandvegetables)过敏原：新鲜食品（如水果和蔬菜）Symptom症状：Itchingofthelips,mouth,palate，throat嘴唇、嘴、上腭咽喉等处立即发痒Hoarsenessand/orswellingofthelips,tongue,uvula,andlarynx嗓音嘶哑，嘴唇、舌头、小舌、喉等肿胀AllergicReactionsAfterIngestionofFood（二）摄入食品后的过敏反应Symptom症状：1）Themainsymptomsofgastrointestinalfoodallergyarevomiting,nausea,diarrhea,andabdominalpains(colicsorcramps).胃肠道主要症状:呕吐、反胃、腹泻以及腹部疼痛（绞痛或痛性痉挛）；2)Skinreactionsincludelocalorgeneralizedpruritus,flush,urticaria,angioedema.morbilliformexanthema,andflare-upofatopicdermatitis皮肤反应：局部的或无显著特点的搔痒症、面部潮红、风疹、血管性水肿、麻疹样疹病、突发特异性皮炎；3)Thesymptomsoftheupperandthelowerrespiratorytractarerhinitis(sneezing,pruritusofthenose,nasalstuffiness,andnasalobstruction),larynxedema,cough,wheezing,andbronchialasthma.上呼吸道或稍低些的呼吸道症状：鼻炎（打喷嚏、鼻搔痒症、鼻子不通气、鼻塞）、喉肿、咳嗽、喘息以及支气管哮喘；4)Itching,redness,andwateringeyes(conjunctivitis)发痒、充血以及眼睛流泪（结膜炎）.AllergicReactionsAfterInhalationofFood（三）吸入食品后的过敏反应Symptom症状：respiratorysymptoms呼吸道综合症Allergen:flour,n-amylase,greencoffee,castorandsoybeans,spices.eggwhite,andcrustaceans过敏原：面粉、α-淀粉酶、绿咖啡、海狸香和大豆、调味品、鸡蛋白以及甲壳动物AllergicReactionsFollowingSkinContactWithFood（四）皮肤接触食品后的过敏反应Allergen:fish,shrimp,flour,andpork过敏原：鱼、小虾、面粉和猪肉Symptom症状：Urticariallesion风疹Chroniccontactwithafoodmayinduceproteincontact,dermatitisinfoodhandlers食品操作工人长期接触某种食品会诱导蛋白接触性皮炎。Non-lgE-MediatedImmuneReactions二、不以IgE为媒介的免疫反应Heiner'sSyndrome,AllergicAlveolitis,andHemorrhagicGastroenteritisinChildhood（一）儿童Heiner综合症、过敏性齿槽炎、出血性肠胃炎DEFINITION：ThetermHeiner'ssyndromecharacterizesamilk-inducedsyndromewithpulmonarydiseaseininfants.Heiner综合症：婴儿因牛奶诱导的肺病Symptom症状：chronicorrecurrentpulmonaryintiltrates慢性或周期性发生的肺渗透allergicalveolitis过敏性齿槽炎achronicrhinitis慢性鼻炎gastrointestinalbloodloss肠胃失血症irondeficiencyanemia缺铁性贫血chroniccough慢性咳嗽recurrentfever周期性发烧Anorexia厌食Vomiting呕吐Colic绞痛Diarrhea腹泻Hemoptysis咳血Control控制措施：institutionofamilk-freediet饮食中去除牛奶Gluten-SensitiveEnteropathy(CeliacDisease)（二）谷蛋白敏感性肠病（乳糜泻）Definition：damagetothesmallintestinalmucosaandsymptomsofmalabsorption定义：小肠黏膜损伤和吸收不良症状小肠黏膜损伤和吸收不良症状Allergen过敏原：Gliadin麦醇溶蛋白presentinwheat,rye,barley,andoat广泛存在于小麦、燕麦、大麦和黑麦中Thepeakincidenceofsymptomsisininfancyaftertheintroductionofcereals;婴儿开始添加谷物类食物时最容易发生这类症状，为第一高峰期；Asecondpeakoccursduringthethirddecade.第二高峰期发生在三十岁。Symptom症状：abdominalpain周期性腹部疼痛loosestools便溏anorexia厌食shortstature体态短小delayedpuberty青春期滞缓nutritionaldeficiencies吸收不良Dentalenamelhypoplasia牙科瓷发育不全recurrentaphthae周期性口疮Control控制措施：Patientswithceliacdiseasemustavoidgliadinsandrelatedproteinspermanently远离麦醇溶蛋白以及相关蛋白质DermatitisHerpetiformis（三）疱疹样皮炎Definition定义：chronicblisteringdisease一种慢性起疱疾病Symptom症状：itchy发痒sometimesburning有时有灼伤感eruptionofgroupedvesiclesonanerythematousground在红斑状范围内出现成群泡样出疹SomeDHpatients,evenwithoutgastrointestinalsymptoms,mayhavevillousatrophysimilartothatseeninceliacdisease有些DH病人甚至在没有出现胃肠道综合症的情况下，也会出现与乳糜泻类似的绒毛状萎缩症，也就是说DH与CD之间有关连。Thecutaneousmanifestationsmayormaynotrespondtoagluten-freediet饮食中排除麦醇溶蛋白可能会、也有可能不会改善皮肤症状。EosinophilicGastroenteritis（四）嗜酸性胃肠炎Definition定义：elevatedeosinophilcountsinbloodandtissueeosinophiliawithreleaseofeosinophiimajorbasicprotein释放嗜曙红细胞主要基本蛋白质后，血液中嗜曙红细胞和嗜曙红血球增多的间质组织内嗜曙红细胞计数值升高Clinicalmanifestations临床症状：vomiting呕吐abdominalpain腹部疼痛Diarrhea腹泻malabsorption吸收不良bowelobstruction肠阻塞Ascites腹水ThecauseofEGisunknown起因还不清楚foodhypersensitivityhasbeensuggestedEG可能由食品超敏性引起UtcerativeColitis（五）溃疡性结肠炎Definition定义：aninflammatoryboweldiseaseofunknownorigin一种不明起因的炎症性肠病NoadversefoodreactionshavebeenshownascausativeofUC还不能证明食品不良反应会造成UCAllergicVasculitis（六）变应性脉管炎Cause起因：foodsandfoodadditives食品及其添加剂Symptom症状：allergicpurpura(widespreadhemorrhagicmaculesandpapules,mainlyonthelowerlegs)demonstratedbysingle