食品安全概論

FoodSensitivities,AllergicReactions,andFoodIntolerances

食品敏感性、過敏性反應(yīng)和食品不耐性

CONTENTS主要內(nèi)容DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION

第一節(jié)食品不良反應(yīng)的定義和機(jī)理SYMPTOMSOFADVERSEFOODREACTIONS

第二節(jié)食品不良反應(yīng)的癥狀DIAGNOSISOFADVERSEFOODREACTIONS

第三節(jié)

食品不良反應(yīng)的診斷法PREVALENCE

第四節(jié)發(fā)病率FOODALLERGENS

第五節(jié)食品過敏原FOODADDITIVES

第六節(jié)食品添加劑FOODLABELINGINRELATIONTOFOODSENSITIVITIES

第七節(jié)與食品過敏性有關(guān)的食品標(biāo)簽DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION

第一節(jié)食品不良反應(yīng)的定義和機(jī)理

Fig.1ClassificationoffoodsproposedbyEAACI圖1EAACI對食品的分級toxicfoodreactions食品毒性反應(yīng)Aclassicaltoxicfoodreactionisscombroidfishpoisoning,duetolargeamountsofhistamine鯖亞目魚組胺中毒是典型的食品毒性反應(yīng)。Foodintolerance食品不耐性

enzymatic(resultingfromanenzymaticdefect,e.g.,lactasedeficiency),“酶促性的”（因酶缺陷造成，如乳糖酶缺乏癥）pharmacological(dependingonthedirecteffectof,e.g.,vaso-activeaminesnaturallyfoundinfoods)“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）“Undefined不明確的”SYMPTOMSOFADVERSEFOODREACTIONS

第二節(jié)食品不良反應(yīng)的癥狀I(lǐng)gE-MediatedFoodAllergy

一、以IgE-為媒介的食品敏感癥

Characteristic特征ClinicalmanifestationsofIgE-mediatedfoodallergycanremainlocalizedatthesiteoftheprimarydirectcontact,i.e.,一直保持在最初的直接接觸部位themouth嘴throat(oralallergysyndrome)咽喉（口腔敏感綜合癥）thegastroiniesrinaltract(isolatedgastrointestinalfoodallergy)胃腸道（單獨(dú)的胃腸道食品敏感癥）SkinRespiratorytractGItractCardievascularS.皮膚呼呼吸道胃胃腸道心臟血管系系統(tǒng)45%25%20%10%Figure2ClassicalsymptomsofIgE-mediatedfoodailergy圖2以IgE為媒媒介的食品品敏感綜合合癥分布OralAllergySyndrome

（一一）口腔敏敏感綜合病病癥Allergen:freshfoods(fruitsandvegetables)過敏原：新鮮食品（（如水果和和蔬菜）Symptom癥癥狀：Itchingofthelips,mouth,palate，throat嘴唇、嘴、、上腭咽喉喉等處立即即發(fā)癢Hoarsenessand/orswellingofthelips,tongue,uvula,andlarynx嗓音嘶啞，，嘴唇、舌舌頭、小舌舌、喉等腫腫脹AllergicReactionsAfterIngestionofFood（（二）攝入入食品后的的過敏反應(yīng)應(yīng)Symptom癥癥狀：1）Themainsymptomsofgastrointestinalfoodallergyarevomiting,nausea,diarrhea,andabdominalpains(colicsorcramps).胃腸道主要要癥狀:嘔嘔吐、反胃胃、腹瀉以以及腹部疼疼痛（絞痛痛或痛性痙痙攣）；2)Skinreactionsincludelocalorgeneralizedpruritus,flush,urticaria,angioedema.morbilliformexanthema,andflare-upofatopicdermatitis皮膚反應(yīng)：：局部的或或無顯著特特點(diǎn)的搔癢癢癥、面部部潮紅、風(fēng)風(fēng)疹、血管管性水腫、、麻疹樣疹疹病、突發(fā)發(fā)特異性皮皮炎；3)Thesymptomsoftheupperandthelowerrespiratorytractarerhinitis(sneezing,pruritusofthenose,nasalstuffiness,andnasalobstruction),larynxedema,cough,wheezing,andbronchialasthma.上呼吸道或或稍低些的的呼吸道癥癥狀：鼻炎（打噴噴嚏、鼻搔搔癢癥、鼻鼻子不通氣氣、鼻塞））、喉腫、、咳嗽、喘喘息以及支支氣管哮喘喘；4)Itching,redness,andwateringeyes(conjunctivitis)發(fā)癢、充血血以及眼睛睛流淚（結(jié)結(jié)膜炎）.AllergicReactionsAfterInhalationofFood（（三）吸吸入食品后后的過敏反反應(yīng)Symptom癥癥狀：respiratorysymptoms呼呼吸道綜綜合癥Allergen:flour,n-amylase,greencoffee,castorandsoybeans,spices.eggwhite,andcrustaceans過敏原：面粉、α-淀粉酶、、綠咖啡、、海貍香和和大豆、調(diào)調(diào)味品、雞雞蛋白以及及甲殼動物物AllergicReactionsFollowingSkinContactWithFood（四）皮膚膚接觸食品品后的過敏敏反應(yīng)Allergen:fish,shrimp,flour,andpork過敏原：魚、小蝦、、面粉和豬豬肉Symptom癥癥狀：Urticariallesion風(fēng)疹Chroniccontactwithafoodmayinduceproteincontact,dermatitisinfoodhandlers食品操作工工人長期接接觸某種食食品會誘導(dǎo)導(dǎo)蛋白接觸觸性皮炎。。Non-lgE-MediatedImmuneReactions二、不以IgE為媒介的免免疫反應(yīng)Heiner'sSyndrome,AllergicAlveolitis,andHemorrhagicGastroenteritisinChildhood（一）兒童童Heiner綜合癥、過過敏性齒槽槽炎、出血血性腸胃炎炎DEFINITION：ThetermHeiner'ssyndromecharacterizesamilk-inducedsyndromewithpulmonarydiseaseininfants.Heiner綜合癥癥：嬰兒因因牛奶誘導(dǎo)導(dǎo)的肺病Symptom癥癥狀：chronicorrecurrentpulmonaryintiltrates慢性性或周期性性發(fā)生的肺肺滲透allergicalveolitis過過敏性齒槽槽炎achronicrhinitis慢性性鼻炎gastrointestinalbloodloss腸腸胃失血癥癥irondeficiencyanemia缺鐵鐵性貧血chroniccough慢性咳咳嗽recurrentfever周周期性發(fā)發(fā)燒Anorexia厭厭食Vomiting嘔嘔吐Colic絞痛Diarrhea腹腹瀉Hemoptysis咳血血Control控控制措施施：institutionofamilk-freediet飲食中去除牛牛奶Gluten-SensitiveEnteropathy(CeliacDisease)（二）谷蛋白白敏感性腸病?。ㄈ槊訛a））Definition：：damagetothesmallintestinalmucosaandsymptomsofmalabsorption定義：小腸黏膜損傷傷和吸收不良良癥狀小腸黏黏膜損傷和吸吸收不良癥狀狀A(yù)llergen過敏敏原：Gliadin麥醇醇溶蛋白presentinwheat,rye,barley,andoat廣泛存在于小小麥、燕麥、、大麥和黑麥麥中Thepeakincidenceofsymptomsisininfancyaftertheintroductionofcereals;嬰兒開始添加加谷物類食物物時(shí)最容易發(fā)發(fā)生這類癥狀狀，為第一高高峰期；Asecondpeakoccursduringthethirddecade.第二高峰期發(fā)發(fā)生在三十歲歲。Symptom癥狀：：abdominalpain周期期性腹部疼痛痛loosestools便溏anorexia厭食shortstature體態(tài)短短小delayedpuberty青青春期滯緩nutritionaldeficiencies吸收收不良Dentalenamelhypoplasia牙牙科瓷發(fā)育育不全recurrentaphthae周期性口口瘡Control控制措措施：Patientswithceliacdiseasemustavoidgliadinsandrelatedproteinspermanently遠(yuǎn)離麥醇溶蛋蛋白以及相關(guān)關(guān)蛋白質(zhì)DermatitisHerpetiformis（（三）皰疹樣樣皮炎Definition定定義：chronicblisteringdisease一種慢性起皰皰疾病Symptom癥狀：：itchy發(fā)癢sometimesburning有時(shí)有灼傷感感eruptionofgroupedvesiclesonanerythematousground在紅斑狀范圍圍內(nèi)出現(xiàn)成群群泡樣出疹SomeDHpatients,evenwithoutgastrointestinalsymptoms,mayhavevillousatrophysimilartothatseeninceliacdisease有些DH病人人甚至在沒有有出現(xiàn)胃腸道道綜合癥的情情況下，也會會出現(xiàn)與乳糜糜瀉類似的絨絨毛狀萎縮癥癥，也就是說說DH與CD之間有關(guān)連連。Thecutaneousmanifestationsmayormaynotrespondtoagluten-freediet飲食中排除麥麥醇溶蛋白可可能會、也有有可能不會改改善皮膚癥狀狀。EosinophilicGastroenteritis（（四）嗜酸性性胃腸炎Definition定定義：elevatedeosinophilcountsinbloodandtissueeosinophiliawithreleaseofeosinophiimajorbasicprotein釋放嗜曙紅細(xì)細(xì)胞主要基本本蛋白質(zhì)后，，血液中嗜曙曙紅細(xì)胞和嗜嗜曙紅血球增增多的間質(zhì)組組織內(nèi)嗜曙紅紅細(xì)胞計(jì)數(shù)值值升高Clinicalmanifestations臨床床癥狀：vomiting嘔吐abdominalpain腹部疼痛Diarrhea腹瀉malabsorption吸收不良bowelobstruction腸阻塞Ascites腹水ThecauseofEGisunknown起因還不清楚楚foodhypersensitivityhasbeensuggestedEG可能由食品超超敏性引起UtcerativeColitis（（五）潰瘍性性結(jié)腸炎Definition定定義：aninflammatoryboweldiseaseofunknownorigin一種不明起因因的炎癥性腸腸病NoadversefoodreactionshavebeenshownascausativeofUC還不能證明食食品不良反應(yīng)應(yīng)會造成UCAllergicVasculitis（（六）變應(yīng)性脈管炎炎Cause起起因：foodsandfoodadditives食品及其添加加劑Symptom癥狀：：allergicpurpura(widespreadhemorrhagicmaculesandpapules,mainlyonthelowerlegs)demonstratedbysinglechallenges變應(yīng)性紫癜（（分布廣泛的的出血性斑丘丘疹，主要出出現(xiàn)在腿的下下部）FoodIntolerance三、食品不耐性LactaseDeficiency乳糖酶缺乏綜綜合征Definition定定義：Lackoftheenzymethatcleavesmilksugar,lactose,givesrisetoadversereactionswhenlactoseisconsumed.當(dāng)攝入乳糖時(shí)時(shí)，由于體內(nèi)內(nèi)缺乏一種能能將牛奶糖質(zhì)質(zhì)----乳糖水解的酶酶，從而產(chǎn)生生不良反應(yīng)Theonlyfoodofwhichlactoseisanaturalconstituentismilk(3.7g/100mlcowsmilk).天然含乳糖的的唯一食品是是牛奶（3.7g/ml牛奶）Classification分分類：1）congenitallactasedeficiency先天性乳糖酶酶缺乏綜合征征2）primarylactasedeficiency初級的乳糖酶酶缺乏綜合征征3）secondarylactasedeficiency二級乳糖酶缺缺乏綜合征1）congenitallactasedeficiency先天性乳糖酶酶缺乏綜合征征lactaseisnotpresentandsymptomswillappearwhenthepatientisbreast-fed.人體內(nèi)不存在在乳糖酶，當(dāng)當(dāng)進(jìn)行人乳哺哺育時(shí)會出現(xiàn)現(xiàn)綜合征Thecongenitalformisveryrare這種癥狀極少少見2）primarylactasedeficiency初級的乳糖酶酶缺乏綜合征征seeninmostoftheworld'spopulationwheretheproductionoflactasedecreasesordisappearsfromtheageof2totheteenageyears在2-10歲時(shí)，乳糖酶酶分泌下降或或消失Persistenthighlactaseactivityinadultlifeoccursamongrelativelyfewethnicgroups:成年人體內(nèi)乳乳糖酶活性一一直處于高峰峰的人群：northernEuropeansandtheiroverseasdescendants北歐歐以及沿海后后代afewAfricangroupsofpastoraltraditionBedouinsandotherSaudiArabs一些源源于牧人的非非洲人、貝都都因人和沙特特阿拉伯人certaingroupsfromwestIndiaandPakistan西印度度和巴基斯坦坦部分人群3）secondarylactasedeficiency二級乳糖酶缺缺乏綜合征aconsequenceofpathologicalchangesinthegutmucosa,asseeninceliacdiseaseorinflammations.乳糜瀉或炎癥癥引起內(nèi)臟黏黏膜病變的結(jié)結(jié)果Whenthegutmucosahasregaineditsnormalappearancethelactaseproductionreappears當(dāng)內(nèi)臟黏膜恢恢復(fù)正常，乳乳糖酶也開始始重新分泌。。Thesymptoms癥狀：：Diarrhea腹瀉瀉gasproduction產(chǎn)產(chǎn)氣Colic絞絞痛Control控制措措施：avoidallproductscontainingevensmallamountsoflactose避免食用任何何含乳糖的食食品PREVALENCE第第四節(jié)發(fā)病率Thetotalprevalenceoffoodallergy/foodintoleranceisnotknown.總發(fā)病率未知知Estimatesbasedondatafromonecountrydonotnecessarilyreflecttheprevalenceofanothercountry在某個(gè)國家統(tǒng)統(tǒng)計(jì)得到的數(shù)數(shù)據(jù)并不能用用到另一個(gè)國國家，因?yàn)椋海?）frequencyanddurationofbreastfeeding母乳喂養(yǎng)的頻頻率和持續(xù)時(shí)時(shí)間2）eatinghabits飲飲食習(xí)慣3）flora植物群群Children一、兒童Food（一）食品allergytocow'smilk,egg,andfishpredominantlybeginsbeforethesecondyearofage對牛奶、雞蛋蛋和魚的過敏敏性主要發(fā)生生2歲以前allergytofruit,legumes,andvegetablespredominantlybeginsafterthesecondyear.對水果、豆類類和蔬菜的過過敏性主要發(fā)發(fā)生在2歲以后Table1PrevalenceofRhinitisandOralItchinDanishSchoolChildren丹麥學(xué)齡兒童童中鼻炎和口口腔發(fā)癢的發(fā)發(fā)病率Age(yr)Rhinitis(%)Oralitch（%)boys/girlsboys/girls5-79.0/5.70/0.38-108.5/7.10.8/1.111-1314.0/8-51.9/1.514-1617.3/13.02.9/2.0FoodAdditives（（二））食品品添加加劑Adversereactionstofoodadditivesarefoundin1-2%ofschoolchildren1-2%學(xué)學(xué)齡兒兒童對對食品品添加加劑有有不良良反應(yīng)應(yīng)Theprevalenceinyoungerchildrenisnotknown.至今不不知小小年齡齡兒童童的發(fā)發(fā)病率率Adults二二、成成年人人Food（一））食品品InEuropeanstudiesthemajorityofallergicfoodreactionsinadultsarecausedbyfruits.vegetables,andnutsandarerelatedtopollenallergy在歐洲洲，大大部分分成年年人食食品過過敏性性反應(yīng)應(yīng)是由由水果果、蔬蔬菜和和堅(jiān)果果引起起的，，且與與花粉粉過敏敏癥有有關(guān)Theprevalenceisaround5%發(fā)病率率在5%左右probablyonly0,5%havesymptomsotherthanoralitch.大約只只有0.5%不是口口腔發(fā)發(fā)癢癥癥狀Theprevalenceofallergytomilk,egg,fish.etc.isaround0.2%，，，牛奶奶、雞雞蛋、、魚等等引起起的過過敏癥癥發(fā)病病率大大約為為0.2%FoodAdditives（（二））食品品添加加劑Theestimatedfrequencywas0.03-0.15%1982年年EEC理理論計(jì)計(jì)算值值：食食品添添加劑劑引起起的發(fā)發(fā)病率率為0.03-0.15%InBritish：：theprevalence大不列列顛人人：發(fā)病率率為0.026%Dutch丹丹麥：0.4%ContactAllergens（（三三）接接觸性性過敏敏原10%Danishwomenhavecontactallergycausedbynickel.10%丹麥麥婦女因因鎳造造成接接觸性性過敏敏癥Upto10%ofthesemaybenefitfromanickel-restricteddiet其中10%以上會會因排排除鎳鎳的飲飲食而而改善善Whatiscontactallergens？Indermallysensitizedsubjectsingestionofthecontactallergenmaycauseskinflarereactionsorothersymptoms,e.g.,inthegastroinlestinaltract皮膚膚敏敏感感癥癥受受檢檢者者攝攝入入接接觸觸性性過過敏敏原原后后會會導(dǎo)導(dǎo)致致皮皮膚膚潮潮間間帶帶反反應(yīng)應(yīng)或或胃胃腸腸道道癥癥狀狀等等其其他他癥癥狀狀。。ContactAllergens：：fragrances芳芳香香物物質(zhì)質(zhì)foodflavors（（naturalorsynthetic））食食品品風(fēng)風(fēng)味味物物Nickel鎳鎳OtherAdverseReactions（（四四））其其它它不不良良反反應(yīng)應(yīng)1））Celiacdisease腹腹部部疾疾病?。海篊ause：：wheatgliadinandrelatedproteins起因因：：小小麥麥麥麥醇醇溶溶蛋蛋白白和和相相關(guān)關(guān)蛋蛋白白質(zhì)質(zhì)Theprevalence：：0.2-0.5%發(fā)病病率率：：0.2-0.5%2））lactasedeficiency乳乳糖糖酶酶缺缺乏乏綜綜合合征征Cause：：Lackoflactase起因因：：缺缺乏乏乳乳糖糖酶酶Theprevalence：：variesfromafewpercentinnorthernEuropeancountriestoalmosttheentireadultpopulationinAsiaandAfrica發(fā)病病率率：：從北北歐歐國國家家到到亞亞洲洲和和非非洲洲國國家家，，成成年年人人發(fā)發(fā)病病率率相相差差好好幾幾個(gè)個(gè)百百分分點(diǎn)點(diǎn)Conclusion：：Itisnotknownwhethertheprevalenceoffoodallergyorintoleranceisincreasing不清清楚楚食食品品過過敏敏/不不耐耐性性的的發(fā)發(fā)病病率率是是否否有有上上升升趨趨勢勢Theprevalenceofpollen-relatedfoodallergieshasincreased.與花粉相相關(guān)食品品敏感癥癥的發(fā)病病率在提提高。FOODALLERGENS第五節(jié)食品過敏敏原Definition定定義Allergensareantigensthatgiverisetoallergy.過敏原是是能引起起敏感的的抗原Whereisfoodallergensfrom？Pollen花花粉Mammals哺乳動動物mites螨otherinsects其他昆昆蟲foods食品品Component：：過敏原原成分：：Proteinsorglycoproteinswithamolecularweightfrom3to90kDa,themajorityrangingfrom10to40kDa已知結(jié)構(gòu)構(gòu)的過敏敏原都是是蛋白質(zhì)質(zhì)或糖蛋蛋白，分分子量從從3kDa到90kDa，大大部分在在10kDa到到40kDa之之間Theidentifiedallergens：：thefirstthreelettersofthegenus,space,thefirstletterofthespecies,space,andanArabicnumber.XXXXX屬種種阿阿拉伯?dāng)?shù)數(shù)字Forexample：Lolp1referstothefirstpollenallergenidentifiedfromLoliumperennc,orryegrassLolp1表示示第一個(gè)個(gè)花粉過過敏原，，來自Loliumperenne或黑麥草草Classification分分類"major"：proteinsforwhich50%ormoreoftheallergicpatientsstudiedhavespecificIgE“主要的的”：能能使50%或以上被被研究病病人具有有特異性性IgE的蛋白質(zhì)質(zhì)"minor““：theremainingallergensareconsideredminor“次要的的”：能能使50%以下的被被研究病病人具有有特異性性IgE的蛋白質(zhì)質(zhì)TheNatureofFoodAllergens一一、過過敏原的的種類Tomakeacompletelistofallergenicfoodsonaglobalbasisisvirtuallyimpossible.我們不可可能列出出一張食食品過敏敏原清單單Whetherafoodallergencausessignificantproblemsinapopulationisdependentonseveralfactors：：某種食品品過敏原原是否會會在消費(fèi)費(fèi)者中引引起明顯顯的問題題取決于于以下幾幾個(gè)方面面：（a）thepotencyoftheallergen過過敏原原的效能能somearemuchmorefrequentsensitizerslhanothers有些抗體體比其他他抗體造造成敏感感癥的次次數(shù)更多多，e.g.,ββ-lactoglobulininmilkorovomucoidfromeggwhite如：牛奶奶中的ββ-乳球球蛋白或或雞蛋蛋蛋白中的的卵類粘粘蛋白（b）thephysiochemicalproperties物物化性質(zhì)質(zhì)：1）Thechemicalstructure,i.e.,theaminoacidsequence,andthetertiarystructure化學(xué)結(jié)構(gòu)構(gòu)如氨基基酸序列列，蛋白白質(zhì)三級級結(jié)構(gòu)2）heatstability熱穩(wěn)穩(wěn)定性3）digestibility可可消化化性4）Structuralrelationshipwithepitopesfromnonfoodallergens非食品過敏敏原與抗原原決定族之之間的結(jié)構(gòu)構(gòu)關(guān)系（c）thefrequencyofexposure

暴露的的頻率：InEuropeallergytoriceandbuckwheatisuncommon.在歐洲，稻稻米和蕎麥麥一般不引引起敏感癥癥InJapanriceandbuckwheatarecommonfoodallergens在日本，稻稻米和蕎麥麥通常是食食品過敏原原。(d)therouteofexposure

暴露露途徑1）aero-allergens：：grasses,pollenoftreesandherbs，，housedustmites，ocatdander飛散過敏原原：草、樹或藥藥草的花粉粉、屋塵螨螨、貓毛發(fā)發(fā)皮屑2）workenvironment：baker工作環(huán)境：：面包工人人3）viatheskin：Naturalrubber(latex)通過皮膚：：天然橡膠膠（e）cross-reactionstoaero-allergens飛散過敏原原的交叉反反應(yīng)1)localspeciesofgrass,trees,andherbsandpollution當(dāng)?shù)厣L的的草、樹以以及藥草種種類e.g.,Allergytohazelnutsiscommoninareaswithmanybirchtrees,wherebirchpollenhayleverisfrequent榛實(shí)敏感癥癥一般發(fā)生生在有許多多樺樹的地地區(qū)，在這這些地區(qū)經(jīng)經(jīng)常發(fā)生樺樺樹花粉熱熱2)airpollution空氣污染染(f)theageatwhichtheallergenisintroduced受受過敏原入入侵的個(gè)體體年齡Inearlyinfancyanincreaseduptakeofantigentakesplaceatatimewhenthegut-associatedlymphoidtissueisstillincompletelydeveloped在幼年早期期，在與消消化道相關(guān)關(guān)淋巴組織織還沒有發(fā)發(fā)育好的時(shí)時(shí)候，抗原原的攝入量量相對較高高。AllergensofAnimalOrigin二二、來源于于動物的過過敏原Milk（一）牛奶奶1）Albumin,β-lactoglobulin,andimmunoglobulinsofmilkarethemostimportantallergensininfants嬰兒：清蛋蛋白、β-乳球蛋白白和免疫球球蛋白2）Inolderchildrenββ-lactoglobulin,caseins,andI-lactalbuminmaybemorereactive.大孩子：ββ-乳球蛋蛋白、酪蛋蛋白和?-乳白蛋白白3）inadulthood：caseintobethemostfrequentallergen成人期：酪酪蛋白cross-reactions交叉叉反應(yīng)Themajorityofpatientswithallergytocow'smilkproteinswillalsoreacttoproteinsfromsheep'sandgoat'smilk大部分對牛牛奶蛋白質(zhì)質(zhì)有敏感癥癥的病人同同樣對綿羊羊奶和山羊羊奶有敏感感癥Cross-reactionsbetweenmilkfromthesespeciesisnotalwayspresent.各種奶之間間的交叉反反應(yīng)并不一一直存在Eggs（（二）雞雞蛋thesecondmostfrequentfoodallergeninsmallchildrenaftercow'smilk在小孩子中中大概是僅僅次于牛奶奶的食品過過敏原Eggwhiteproteinsarereportedtoelicitallergicreactionsmorefrequentlythaneggyolk.雞蛋蛋白比比蛋黃更易易引起過敏敏反應(yīng)蛋黃中的主主要過敏原原Protein蛋白質(zhì)Name分類名molecularweight分子量(kDa)Contentineggwhite雞蛋白中的含量(%)Ovomucoid(*key)卵類粘蛋白Gald12800011Ovalbumin卵清蛋白Gald24500054Ovotransferrinorconalbumin卵鐵傳遞蛋白或伴清蛋白Gald37800012Lysozyme溶菌酶Gald4140003.4cross-reactions交叉叉反應(yīng):allergytoeggcanbecorrelatedtoallergytobirdfeathers雞蛋敏感癥癥與鳥類羽羽毛敏感癥癥之間有相相關(guān)性themajorcross-reactingdeterminantsarethelivetinsfromeggyolk.主要交叉反反應(yīng)的決定定因素是蛋蛋黃中的卵卵黃蛋白AllergensofPlantOrigin

三、、來源于植植物的過敏敏原Thevegetablefoodsthatmostcommonlycausehypersensitivitysymptoms致敏性蔬菜菜種類hazelnut榛榛實(shí)Walnut胡桃桃Brazilnut巴西西堅(jiān)果Apple蘋果Almond杏仁仁Peach桃子Plum李李子Cherry櫻桃桃Peanut花生生Peas豌豌豆Carrot胡蘿蘿卜parsley歐歐芹芹Celery芹芹菜菜Orange橘橘子子Strawberry草草莓莓Cereals谷谷物物Therankinglistsvarydependingon各各種種蔬蔬菜菜致致敏敏程程度度的的影影響響因因素素1））theageofthepatients病人人的的年年齡齡2））themethodsofdiagnosis診斷斷方方法法以以及及3））thegeographiclocationofthepopulation地理理環(huán)環(huán)境境Fruits,Nuts,andVegetables（（一一））水水果果、、堅(jiān)堅(jiān)果果和和蔬蔬菜菜Morethan90%ofpatientswithsensitizationtovegetablefoodshadconcomitantsensitizationtopollen90%以上上的蔬蔬菜菜敏敏感感癥癥總總是是伴伴隨隨著著花花粉粉敏敏感感癥癥而而來來Inagroupofbirchpollenallergiesthepatientswithadditionalhypersensitivitytonutsandappleshad：：在一組同時(shí)有有另外的堅(jiān)果果和蘋果超敏敏性的樺樹花花粉敏感癥病病人中(1)moreseveresymptomsduringthepollenseason在花粉季節(jié)癥癥狀嚴(yán)重加重重(2)highervaluesofIgEtobirchandhazelpollen,樺樹和榛子花花粉的IgE值較高(3)alargerareaoftheskinpricktestreactivetobirchandhazelpollencomparedtothegroupwithoutappleandnutallergy與那些沒有堅(jiān)堅(jiān)果和蘋果超超敏性病人相相比，樺樹和和榛子花粉的的皮膚穿刺試試驗(yàn)反應(yīng)區(qū)域域要大得多。。Thesymptoms主要要癥狀：Mainlyfromthemouthandpharynx,withitching,swellingofthelips,tongue,andthroat.syndrome.從嘴到咽發(fā)癢癢，嘴唇、舌舌頭以及咽喉喉腫脹Thesesymptomsarecalledthe““oralallergy”“口腔敏感綜綜合癥”cross-reactions交交叉反應(yīng):1）Asensitizationtomugwortpollensanddifferentspices,theso-calledmugwort-celery-spicessyndrome,hasbeenreported艾蒿及其不同同種艾屬植物物的花粉有致致敏性，又稱稱艾蒿-芹菜--香料綜合癥。。2）Itwasshownbyprick,RASTstudies,andRASTinhibitionexperiments皮膚穿刺、RSAT研究以及RSAT抑制實(shí)驗(yàn)證明明：acelery-thermolabileallergenseemstobeinvolvedincelery-birch-pollen-allergicpatients一種不耐熱芹芹菜過敏原會會導(dǎo)致芹菜-樺樹-花粉敏感癥athermostableallergenisinvolvedincelery-mugwort-allergicpatients.一種耐熱過敏敏原會導(dǎo)致芹芹菜-艾蒿敏感癥Pollen-relatedfoodallergiesarethoughttobecausedbycross-reactionsofpollen-specificIgEantibodieswithepitopesoffoodproteins.花粉特異IgE抗體與食食品蛋白質(zhì)的的抗原決定族族發(fā)生交叉反反應(yīng)，導(dǎo)致了了花粉相關(guān)食食品敏感癥Threedistinctcross-reactivestructuresinpollenandvegetablefoods花花粉和蔬菜菜中的3個(gè)明顯交叉反反應(yīng)結(jié)構(gòu)1）BetvlisthemajorbirchpollenallergenBetv1是主要的樺樹樹花粉過敏原原Allergenswithcross-reactivitytoBetv1：與Betv1有交叉反應(yīng)的的過敏原有：：Apples蘋果Hazelnuts榛實(shí)cherries櫻桃Pears梨子Celery艾蒿carrots胡蘿卜2）Profilinsarewidelydistributedintheplantkingdomandhavebeenidentifiedas"plantpanAllergens."Profilin廣泛分布在植植物王國，被被稱為“植物物pan過敏原”10to20%ofthepollen-allergicpatientsaresensitizedtopronlins.10-20%花粉敏感病人人對profilins敏感3）Cross-reactionsofallergen-specificIgEantibodiescanbecausedbyso-called"cross-reactivecarbohydratedeterminants"offoodandpollenglycoproteins.食品和花粉糖糖蛋白，又稱稱為“交叉叉反應(yīng)碳水化化合物決定物物”會引起過敏原與特異異性IgE抗抗體的交叉反反應(yīng)。Cereals

（二二）谷物twomajorallergens：：兩個(gè)主要過敏敏原IgE：oneat47kDaoneat20kDaWhenchallengedwithdouble-blind,placebo-controlledfoodchallengeDBPCFC實(shí)驗(yàn)證實(shí)21%ofthepatientswithsuspectedallergytocerealshadsymptoms21%谷物過過敏兒童有綜綜合癥狀8%hadclinicalreactionstoonlyonecereal8%兒童只對對一種谷物有有臨床反應(yīng)Themajorityofthechildrenhadclinicalreactionstowheat(76%)大部分兒童（（76%）對對谷物有臨床床反應(yīng)Legumes（三）豆類PeanutallergymaybethemostcommonfoodallergyintheUnitedStates在美國，花生生敏感癥是最最常見的食品品敏感癥Allergicreactionsareoftenacuteandsevere過敏反應(yīng)經(jīng)常常是急性和嚴(yán)嚴(yán)重的Themajorpeanutallergen：：主要的花生過過敏原：glycoprotein糖蛋白Arah1，molecularweightof66kDaArah2,molecularweightof17kDa{Thecharacteristic特征：：heatstable熱穩(wěn)穩(wěn)定性apotentialsourceof"hiddenfoodallergens一種“隱藏性性食品過敏原原”的潛在資資源NaturalRubber(Latex)-RelatedFoodAllergens（四））與天天然橡橡膠（（乳膠膠）有有關(guān)食食品過過敏原原Thelatexallergensareproteinsfromtherubbertree乳汁過過敏原原是來來自橡橡膠樹樹的蛋蛋白質(zhì)質(zhì)Commonantigenicdeterminantsdemonstratedbetweenlatexandavocado,chestnut,andbanana乳汁與鱷梨梨、栗子和和香蕉之間間存在共同同的抗原定定子Allergytonaturalrubber(latex)hasbecomeincreasinglyproblematic天然橡膠膠（乳汁））敏感癥有有上升趨勢勢Thesereactionsaresevere,e.g.,anaphylacticshock許多反應(yīng)是是嚴(yán)重的，，如過敏性性休克FOODADDITIVES第六節(jié)食品添加劑劑Chemicallyandfunctionallyfoodadditivesareaveryheterogeneousgroupofsubstancesconsistingof：化學(xué)性的和和功能性的的食品添加加劑的組成成：Enzymes酶酶Flavors風(fēng)風(fēng)味物Colors色色素Preservatives防腐劑劑Emulsifiers乳乳化劑Antioxidants抗抗氧化劑劑Sweeteners甜甜味劑Colors一、色素AzoColors（一）含氮色素Theazocolorscauseadversereactions:會造成不良良反應(yīng)的含含氮色素：：tartrazine酒石黃黃sunsetyellow落日黃azorubin/carmoisin偶氮玉玉紅amaranth莧莧菜紅ponceau4R麗春紅紅4RSymptoms:mainlyontheskinandmainlyurticaria主要癥狀：：皮膚風(fēng)疹疹Tartrazinehasbeentheadditiveofchoicewhenresearchershavetriedtoelucidatethemechanismoffood-additiveintolerance酒石黃作為為機(jī)理實(shí)驗(yàn)驗(yàn)物apharmacologicaleffectoftartrazineandotherazocolors酒石黃和其其他含氮色色素具有藥藥物學(xué)影響響pharmacologicaleffect：藥物學(xué)影響響：alargecumulativedoseoftartrarine(200mg)innormalsubjectsresultedinasignificantriseinplasmaandurinaryhistaminelevels.患者體內(nèi)酒酒石黃積累累到很高濃濃度時(shí)，血血漿和尿液液中組胺濃濃度明顯升升高Thehistaminereleasewasnotaccompaniedbysystemicsymptoms全身組織綜綜合癥狀導(dǎo)導(dǎo)致組胺不不能完全釋釋放出來Nonazocolors

（二二）無氮色素Nonazocolorscouldgiveadversereactions:會造成不良良反應(yīng)的無無氮色素：：Annatto果果紅Indigo靛靛藍(lán)Carmine胭胭脂紅紅Erythrosine赤赤蘚紅patentblue專專利藍(lán)(三三苯甲烷系系染料）Symptoms:mainlyontheskinandmainlyurticaria主要癥狀為為皮膚風(fēng)疹疹Preservatives二、防腐劑劑BenzoicandSorbicAcid（（一）安安息香酸和和山梨酸causesofurticaria造成接觸性性風(fēng)疹provokeitchingandtinglinginthemouth出現(xiàn)口腔發(fā)發(fā)癢和麻刺刺感Themechanismisnotknown其致病機(jī)制制未知Sulfites（二）亞硫酸鹽symptoms癥癥狀：asthma哮哮喘anaphylacticreactions皮皮膚過敏symptomsontheskin皮皮膚綜合癥癥thelikelihoodofareactiondependon：致敏反應(yīng)的的可能性取取決于：Thenatureofthefood食品的的特性thelevelofresidualsulfite亞硫酸鹽鹽的殘留水水平thesensitivityofthepatient病人的的敏感性theformofresidualsulfite亞亞硫酸鹽的的殘留形式式themechanismofthesulfite-inducedreaction亞硫酸鹽誘誘導(dǎo)反應(yīng)機(jī)機(jī)理thecauseofasthmaticreactionstosulfltesinfood亞亞硫酸鹽鹽哮喘反應(yīng)應(yīng)的原因：：inhalationofsulfurdioxideliberatedduringingestion食用時(shí)吸入入了二氧化化硫deficiencyofsulfiteoxidase缺乏亞硫酸酸鹽氧化酶酶Metabisulfite偏亞亞硫酸氫鈉鈉Metabisulfite-inducedbasophilhistaminereleaseinanonasthmaticpatient偏亞硫酸氫氫鹽具有誘誘發(fā)嗜堿細(xì)細(xì)胞釋放組組胺的功能能developedurticariaandangioedemafollowingprovocationwithsodiummetabisulfite偏亞硫酸氫氫鈉激發(fā)會會造成風(fēng)疹疹和血管性性水腫anIgE-mediatedreaction偏亞硫酸氫氫鈉的敏感感性是一種種以IgE為媒介的的反應(yīng)FlavorEnhancersandFlavors三、風(fēng)味促促進(jìn)劑和香香精FlavorEnhancers:MonosodiumGlutamate（（一）風(fēng)味味促進(jìn)劑：：味精Theresultofmonosodiumglutamate(MSG)wastheChineserestaurantsyndrome(CRS)andasthma。味精會造成成：中國餐館綜綜合癥（CRS）喘病癥1）symptomsofCRS癥狀狀：headache頭痛aburningsensationalongthebackoftheneck沿著脖子背背部的灼熱熱感chesttightness胸悶Nausea作嘔Sweating發(fā)汗SymptomscharacteristicoftheChineserestaurantsyndromecanbeprovokedinalimitednumberofindividualsbyhighconc