食品敏感性過敏性反應(yīng)和食品不耐性.ppt

1、Food Sensitivities, Allergic Reactions, and Food Intolerances食品敏感性、過敏性反應(yīng)和食品不耐性,Allergens,Employees should be aware of major allergens and the menu items that contain them. When serving customers with food allergies, servers must be ready to answer customers questions about any menu item. Servers sho

2、uld never take a guess about what a menu item contains. If they dont know, they should ask someone who does. Cross-contact occurs when allergens are transferred from food containing an allergen to the food served to the customer.,2,A food allergy is the bodys negative reaction to a food protein.,CON

3、TENTS 主要內(nèi)容,DEFINITION AND MECHANISMS OF ADVERSE FOOD REACTION第一節(jié) 食品不良反應(yīng)的定義和機(jī)理 SYMPTOMS OF ADVERSE FOOD REACTIONS第二節(jié) 食品不良反應(yīng)的癥狀 DIAGNOSIS OF ADVERSE FOOD REACTIONS第三節(jié) 食品不良反應(yīng)的診斷法,PREVALENCE第四節(jié) 發(fā)病率 FOOD ALLERGENS第五節(jié) 食品過敏原 FOOD ADDITIVES第六節(jié) 食品添加劑 FOOD LABELING IN RELATION TO FOOD SENSITIVITIES 第七節(jié) 與食品過敏性

4、有關(guān)的食品標(biāo)簽,DEFINITION AND MECHANISMS OF ADVERSE FOOD REACTION第一節(jié) 食品不良反應(yīng)的定義和機(jī)理,6,概 述,食物過敏和食物不耐受都是機(jī)體對(duì)食物的不良反應(yīng)過程； 食物過敏是由所攝入的食物或食物成分所引發(fā)的一種免疫反應(yīng)；與食物或食物成分的生理學(xué)作用無關(guān)； 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)體免疫反應(yīng)無關(guān)。,Fig.1 Classification of foods proposed by EAACI 圖1 EAACI對(duì)食品的分級(jí),toxic food reactions 食品毒性反應(yīng),A classical tox

5、ic food reaction is scombroid fish poisoning, due to large amounts of histamine 鯖亞目魚組胺中毒是典型的食品毒性反應(yīng)。,Food intolerance 食品不耐性,enzymatic (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） pharmacological (depending on the direct effect of, e.g., vaso-active amines na

6、turally 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） “Undefined不明確的”,10,相關(guān)定義介紹,超敏反應(yīng)（hypersensitivity） 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)； 正常人可以耐受。 過敏（allergy） 由免疫機(jī)制介導(dǎo)的超敏反應(yīng)； 是對(duì)一些食物中的無害蛋白（牛奶蛋白）、花粉、頭皮屑、寵物、屋塵螨的過度免疫反應(yīng),11,特應(yīng)性反應(yīng)（atopy） 具有家庭遺傳傾向，對(duì)于小劑量的過敏原能產(chǎn)生大量的IgE抗體； 發(fā)展為過敏癥的可能性增加,12,食物過敏機(jī)制,13,定 義,食物過敏是指?jìng)€(gè)體在攝入某種食物之

7、后，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、胃腸道、呼吸道以及心血管系統(tǒng)等。,14,過敏發(fā)展歷程,過敏歷程 食物過敏 螨蟲 花粉過敏 濕疹 消化道過敏癥 喘息 鼻炎 、過敏性哮喘、慢性特應(yīng)性皮炎（濕疹） 惡性循環(huán) 一種過敏原 多種過敏原 累及一個(gè)組織/器官 累及多個(gè)組織/器官,15,流行病學(xué)特點(diǎn),目前尚無確切的食物過敏流行病學(xué)數(shù)據(jù)，呈增加趨勢(shì)； 8%的兒童和2%4%的成人可能受食物過敏的影響； 絕大多數(shù)食物過敏癥狀發(fā)生在1歲之內(nèi)； 有家族遺傳過敏性疾病的個(gè)體中發(fā)生率高。,16,食物過敏的分類,IgE依賴型食物過敏：即I 型變態(tài)反應(yīng)，有肥大細(xì)胞和IgE參與反應(yīng)，呈速

8、發(fā)反應(yīng)，臨床表現(xiàn)為鼻炎、哮喘、濕疹、蕁麻疹等； IgE非依賴型食物過敏：包括型、 型和型,17,IgE依賴型食物過敏,最主要的類型； 致敏階段：食物過敏原刺激特異性IgE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、巨噬細(xì)胞等表面； 激發(fā)階段：當(dāng)再次暴露于食物抗原時(shí)，抗原與IgE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； 這些介質(zhì)會(huì)引發(fā)血管舒張、平滑肌收縮、以及粘液釋放-即速發(fā)型過敏反應(yīng)； 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IgE調(diào)節(jié)的遲發(fā)過敏反應(yīng)。,三、IgE依賴型食物過敏-發(fā)病機(jī)理,20,非IgE依賴型食物過敏,研究較少； 型變態(tài)反應(yīng)（抗原抗體復(fù)合物調(diào)

9、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，它們將被血管濾膜組織（如腎小球）截獲，沉積，激活補(bǔ)體，導(dǎo)致血管組織受害； 型變態(tài)反應(yīng)（細(xì)胞調(diào)節(jié)）：T細(xì)胞識(shí)別特異性抗原，通過細(xì)胞免疫途徑，造成臨近宿主細(xì)胞的破壞，癥狀一般在攝入抗原食物之后幾小時(shí)出現(xiàn)。,21,人類的進(jìn)化似乎給現(xiàn)代人類的健康設(shè)下了陷阱 之一：無所作為的IgE,病理作用：抗寄生蟲作用； 現(xiàn)代生活中寄生蟲感染幾乎銷聲匿跡 IgE的作用何在： 儲(chǔ)備； 致病,為維系胎兒的生存，避免母胎之間的排斥，胎兒期Th1應(yīng)答低下； 生后維持Th2傾向； Th2應(yīng)答傾向是過敏性疾病的免疫學(xué)基礎(chǔ)。,人類的進(jìn)化似乎給現(xiàn)代人類的健康設(shè)下了陷阱 之二：與生懼

10、來的Th2傾向,食物過敏的發(fā)病機(jī)制,-兩大陷阱的作用,22,食物過敏的免疫機(jī)制,Th1,Th2,參與抗感染過程，殺死被細(xì)菌、病毒感染的細(xì)胞和腫瘤細(xì)胞，抑制B細(xì)胞產(chǎn)生IgE,使炎癥細(xì)胞釋放組胺，使B細(xì)胞產(chǎn)生IgE，引起過敏反應(yīng),調(diào)節(jié)性T淋巴細(xì)胞,23,新生兒的Th2傾向,24,25,“衛(wèi)生假說”的提出,目的：解釋不斷增加的過敏性并的發(fā)病率； 1989年，流行病學(xué)專家Dr Strachan提出來的； 家庭規(guī)模與過敏呈負(fù)相關(guān)； 同一家庭中年幼兒比年長(zhǎng)兒過敏的發(fā)生率高 提出兒童早期感染減少，接觸同胞機(jī)會(huì)減少是過敏性疾病升高的原因； 微生物接觸有助于刺激Th1的增強(qiáng),SYMPTOMS OF ADVERS

11、E FOOD REACTIONS第二節(jié) 食品不良反應(yīng)的癥狀,IgE-Mediated Food Allergy一、以IgE-為媒介的食品敏感癥,Characteristic 特征,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 gastroiniesrin

12、al tract (isolated gastrointestinal food allergy)胃腸道（單獨(dú)的胃腸道食品敏感癥）,Skin Respiratory tract GI 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,Oral Allergy Syndrome （一）口腔敏感綜合病癥,Allergen: fresh foods( fruits and vege

13、tables) 過敏原：新鮮食品（如水果和蔬菜）,Symptom 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 of the lips, tongue, uvula, and larynx 嗓音嘶啞，嘴唇、舌頭、小舌、喉等腫脹,Allergic Reactions After Ingestion of Food （二）攝入食品后的過敏反應(yīng),Symptom 癥狀： 1）The main symptoms of gastrointestinal food aller

14、gy 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, urticaria, angioedema. morbilliform exanthema, and flare-up of atopic dermatitis 皮膚反應(yīng)：局部的或無顯著特點(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；

15、,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, 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 (co

16、njunctivitis) 發(fā)癢、充血以及眼睛流淚（結(jié)膜炎）.,Allergic Reactions After Inhalation of Food （三）吸入食品后的過敏反應(yīng),Symptom 癥狀： respiratory symptoms 呼吸道綜合癥,Allergen: flour, n-amylase, green coffee, castor and soy beans, spices. egg white, and crustaceans 過敏原：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,Allergic Reactions Following Skin

17、Contact With Food（四）皮膚接觸食品后的過敏反應(yīng),Allergen: fish, shrimp, flour, and pork 過敏原：魚、小蝦、面粉和豬肉,Symptom 癥狀： Urticarial lesion 風(fēng)疹 Chronic 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。,Non-lgE-Mediated Immune Reactions二、不以IgE為媒介的免疫反應(yīng),Heiners Syndrome, Al

18、lergic Alveolitis, and Hemorrhagic Gastroenteritis in Childhood（一）兒童Heiner綜合癥、過敏性齒槽炎、出血性腸胃炎,DEFINITION：The term Heiners syndrome characterizes a milk-induced syndrome with pulmonary disease in infants. Heiner綜合癥：嬰兒因牛奶誘導(dǎo)的肺病,Symptom 癥狀： chronic or recurrent pulmonary intiltrates 慢性或周期性發(fā)生的肺滲透 allergic

19、alveolitis 過敏性齒槽炎 a chronic rhinitis 慢性鼻炎 gastrointestinal blood loss 腸胃失血癥 iron deficiency anemia 缺鐵性貧血 chronic cough 慢性咳嗽 recurrent fever 周期性發(fā)燒 Anorexia 厭食 Vomiting 嘔吐 Colic 絞痛 Diarrhea 腹瀉 Hemoptysis 咳血,Control 控制措施： institution of a milk-free diet 飲食中去除牛奶,Gluten-Sensitive Enteropathy (Celiac Dise

20、ase)（二）谷蛋白敏感性腸?。ㄈ槊訛a）,Definition：damage to the small intestinal mucosa and symptoms of malabsorption 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,Allergen 過敏原： Gliadin 麥醇溶蛋白 present in wheat, rye, barley, and oat 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; 嬰兒開始添

21、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。,Symptom 癥狀： abdominal pain周期性腹部疼痛 loose stools便溏 anorexia厭食 short stature體態(tài)短小 delayed puberty青春期滯緩 nutritional deficiencies吸收不良 Dental enamel hypoplasia 牙科瓷發(fā)育不全 recurrent aphthae周期性口瘡,Control 控制措施： Patients with celi

22、ac 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),Dermatitis Herpetiformis （三）皰疹樣皮炎,Definition 定義： chronic blistering disease 一種慢性起皰疾病,Symptom 癥狀： itchy 發(fā)癢 sometimes burning 有時(shí)有灼傷感 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,Some DH patients, e

23、ven without gastrointestinal symptoms, may have villous atrophy similar to that seen in celiac disease 有些DH病人甚至在沒有出現(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DH與CD之間有關(guān)連。 The cutaneous manifestations 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。,Eosinophilic Gastroenteritis （四）嗜酸性胃腸

24、炎,Definition 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,Clinical manifestations 臨床癥狀： vomiting 嘔吐 abdominal pain 腹部疼痛 Diarrhea 腹瀉 malabsorption 吸收不良 bowel obstruction 腸阻塞 Ascites 腹水,T

25、he cause of EG is unknown 起因還不清楚 food hypersensitivity has been suggested EG可能由食品超敏性引起,Utcerative Colitis （五）潰瘍性結(jié)腸炎,Definition 定義： an inflammatory bowel disease of unknown origin 一種不明起因的炎癥性腸病,No adverse food reactions have been shown as causative of UC 還不能證明食品不良反應(yīng)會(huì)造成UC,Allergic Vasculitis（六）變應(yīng)性脈管炎,C

26、ause 起因： foods and food additives 食品及其添加劑,Symptom 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）,Food Intolerance三、食品不耐性,Lactase Deficiency乳糖酶缺乏綜合征,Definition 定義： Lack of the enzyme that cleav

27、es 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),The 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）,Classification 分類： 1） congenital lactase deficiency先天性乳糖酶缺乏綜合征 2）

28、 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,2） primary lactase deficiency

29、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,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： northern Europeans and th

30、eir overseas descendants北歐以及沿海后代 a 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 certain groups from west India and Pakistan西印度和巴基斯坦部分人群,3） secondary lactase deficiency二級(jí)乳糖酶缺乏綜合征 a consequence of pathological changes in the gut mucosa, as seen in celia

31、c 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，乳糖酶也開始重新分泌。,The symptoms 癥狀： Diarrhea 腹瀉 gas production 產(chǎn)氣 Colic 絞痛,Control 控制措施： avoid all products containing even small amounts of lactose 避免食用任何含乳糖的食品,P

32、REVALENCE第四節(jié) 發(fā)病率,The total prevalence of food allergy/food intolerance is not known. 總發(fā)病率未知 Estimates 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?1） frequency and duration of breast feeding 母乳喂養(yǎng)的頻率和持續(xù)時(shí)間 2）eating habits飲食習(xí)慣 3）

33、 flora植物群,Children一、兒童,Food（一）食品,allergy to cows milk, egg, and fish predominantly begins before the second year of age 對(duì)牛奶、雞蛋和魚的過敏性主要發(fā)生2歲以前 allergy to fruit, legumes, and vegetables predominantly begins after the second year. 對(duì)水果、豆類和蔬菜的過敏性主要發(fā)生在2歲以后,Table 1 Prevalence of Rhinitis and Oral Itch in Da

34、nish School Children 丹麥學(xué)齡兒童中鼻炎和口腔發(fā)癢的發(fā)病率,Food Additives （二）食品添加劑,Adverse 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) The prevalence in younger children is not known. 至今不知小年齡兒童的發(fā)病率,Adults二、成年人,Food （一）食品,In European studies the majority of allergic food reactio

35、ns 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敏性反應(yīng)是由水果、蔬菜和堅(jiān)果引起的，且與花粉過敏癥有關(guān) The prevalence is around 5% 發(fā)病率在5%左右,probably only 0,5% have symptoms other than oral itch. 大約只有0.5%不是口腔發(fā)癢癥狀 The prevalence of allergy to milk, egg, fish. etc. is around

36、 0.2%，牛奶、雞蛋、魚等引起的過敏癥發(fā)病率大約為0.2%,Food Additives （二）食品添加劑,The 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%,In British ：theprevalence 大不列顛人 ：發(fā)病率為0.026% Dutch 丹麥 ：0.4%,Contact Allergens （三）接觸性過敏原,10 % Danish women have contact allergy caused by nickel. 10%丹麥婦女因鎳造成接觸性過敏癥 Up to 1

37、0% 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,What is contact allergens？ In dermally sensitized subjects ingestion of the contact allergen may cause skin flare reactions or other symptoms, e.g., in the gastroinlestinal tract 皮膚敏感癥受檢者攝入接觸性過敏原后會(huì)導(dǎo)致皮膚潮間帶反應(yīng)或胃腸道癥狀等其他癥狀。,Contact

38、Allergens： fragrances 芳香物質(zhì) food flavors（natural or synthetic）食品風(fēng)味物 Nickel 鎳,Other Adverse Reactions （四）其它不良反應(yīng),1）Celiac disease腹部疾病： Cause：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 deficiency 乳糖酶缺乏綜合征 Cause：Lack of lactase 起因：缺乏乳糖酶 The preva

39、lence ： varies from a few percent in northern European countries to almost the entire adult population in Asia and Africa 發(fā)病率：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),Conclusion： It is not known whether the prevalence of food allergy or intolerance is increasing 不清楚食品過敏/不耐性的發(fā)病率是否有上升趨勢(shì) The prevalence of pollen-r

40、elated food allergies has increased. 與花粉相關(guān)食品敏感癥的發(fā)病率在提高。,FOOD ALLERGENS第五節(jié) 食品過敏原,Definition 定義,Allergens are antigens that give rise to allergy . 過敏原是能引起敏感的抗原 Foreign, non-self substances 外來的，非自身物質(zhì)；,Where is food allergens from？,Pollen花粉 Mammals哺乳動(dòng)物 mites螨 other insects其他昆蟲 foods食品,Component：過敏原成分： P

41、roteins 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)都是潛在的過敏原，尤其是那些容易導(dǎo)致Th2應(yīng)答的蛋白質(zhì)。,The identified allergens：,the fir

42、st three letters of the genus, space, the first letter of the species, space, and an Arabic number. XXX X X 屬 種 阿拉伯?dāng)?shù)字 For 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)花粉過敏原，來自Lolium perenne 或黑麥草,Classification 分類,major： proteins for wh

43、ich 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) minor“：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,過敏食物,含有過敏原結(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、花生等）； 穩(wěn)定、食物加工過程中不受破壞； 抵抗胃腸道的消化,93,易引起過敏的食物,The Nature of Food Al

44、lergens一、過敏原的種類,To 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敏原清單 Whether a food allergen causes significant problems in a population is dependent on several factors： 某種食品過敏原是否會(huì)在消費(fèi)者中引起明顯的問題取決于以下幾個(gè)方面：,（a）the potency of the allergen過敏原的效能,some are

45、much more frequent sensitizers lhan 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,（b）the physiochemical properties物化性質(zhì)：,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 stabili

46、ty 熱穩(wěn)定性 3）digestibility 可消化性 4）Structural relationship with epitopes from nonfood allergens 非食品過敏原與抗原決定族之間的結(jié)構(gòu)關(guān)系,（c） the frequency of exposure暴露的頻率：,In Europe allergy to rice and buckwheat is uncommon. 在歐洲，稻米和蕎麥一般不引起敏感癥 In Japan rice and buckwheat are common food allergens 在日本，稻米和蕎麥通常是食品過敏原。,(d) the

47、route of exposure 暴露途徑,1）aero-allergens：grasses, pollen of trees and herbs ， house dust mites ，o cat dander 飛散過敏原：草、樹或藥草的花粉、屋塵螨、貓毛發(fā)皮屑 2）work environment：baker 工作環(huán)境：面包工人 3）via the skin：Natural rubber (latex) 通過皮膚：天然橡膠,（e） cross-reactions to aero-allergens飛散過敏原的交叉反應(yīng),1) local species of grass, trees, a

48、nd herbs and pollution 當(dāng)?shù)厣L(zhǎng)的草、樹以及藥草種類 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)生在有許多樺樹的地區(qū)，在這些地區(qū)經(jīng)常發(fā)生樺樹花粉熱 2) air pollution空氣污染,(f) the age at which the allergen is introduced受過敏原入侵的個(gè)體年齡,In early infancy an increased uptake o

49、f 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)淋巴組織還沒有發(fā)育好的時(shí)候，抗原的攝入量相對(duì)較高。,Allergens of Animal Origin二、來源于動(dòng)物的過敏原,Milk （一）牛奶,1）Albumin, -lactoglobulin, and immunoglobulins of milk are the most important allergens in infants 嬰兒：清蛋白、-乳

50、球蛋白和免疫球蛋白 2） 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) The majority of patients with allergy to cows milk proteins will also react to proteins from sheeps

51、and goats 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,Eggs（二）雞蛋,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敏原 Egg white proteins are reported to elicit allergic reactions mo

52、re frequently than egg yolk. 雞蛋蛋白比蛋黃更易引起過敏反應(yīng),蛋黃中的主要過敏原,cross-reactions交叉反應(yīng): allergy to egg can be correlated to allergy to bird feathers 雞蛋敏感癥與鳥類羽毛敏感癥之間有相關(guān)性 the 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,Allergens of Plant Origin三、來源于植物的過敏原,The vegetable f

53、oods that most commonly cause hypersensitivity symptoms致敏性蔬菜種類,hazelnut 榛實(shí) Walnut 胡桃 Brazil nut 巴西堅(jiān)果 Apple 蘋果 Almond 杏仁 Peach 桃子 Plum 李子 Cherry 櫻桃,Peanut 花生 Peas 豌豆 Carrot 胡蘿卜 parsley 歐芹 Celery 芹菜 Orange 橘子 Strawberry 草莓 Cereals 谷物,The ranking lists vary depending on各種蔬菜致敏程度的影響因素,1）the age of the pa

54、tients 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,Fruits, Nuts, and Vegetables （一）水果、堅(jiān)果和蔬菜,More than 90% of patients with sensitization to vegetable foods 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,In a group of birch pollen allergi

55、es the patients with additional hypersensitivity to nuts and apples had： 在一組同時(shí)有另外的堅(jiān)果和蘋果超敏性的樺樹花粉敏感癥病人中 (1) more severe symptoms during the pollen season 在花粉季節(jié)癥狀嚴(yán)重加重 (2) higher values of IgE to birch and hazel pollen, 樺樹和榛子花粉的IgE值較高 (3) a larger area of the skin prick test reactive to birch and hazel

56、pollen compared to the group without apple and nut allergy 與那些沒有堅(jiān)果和蘋果超敏性病人相比，樺樹和榛子花粉的皮膚穿刺試驗(yàn)反應(yīng)區(qū)域要大得多。,The symptoms 主要癥狀： Mainly from the mouth and pharynx, with itching, swelling of the lips, tongue, and throat. syndrome. 從嘴到咽發(fā)癢，嘴唇、舌頭以及咽喉腫脹 These symptoms are called the “oral allergy” “口腔敏感綜合癥”,cross

57、-reactions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

58、 seems to be involved in celery-birch-pollen-allergic patients 一種不耐熱芹菜過敏原會(huì)導(dǎo)致芹菜-樺樹-花粉敏感癥 a thermostable allergen is involved in celery -mug wort-allergic patients. 一種耐熱過敏原會(huì)導(dǎo)致芹菜-艾蒿敏感癥,Pollen-related food allergies are thought to be caused by cross-reactions of pollen-specific IgE antibodies with epito

59、pes of food proteins. 花粉特異IgE抗體與食品蛋白質(zhì)的抗原決定族發(fā)生交叉反應(yīng)，導(dǎo)致了花粉相關(guān)食品敏感癥,Three distinct cross-reactive structures in pollen and vegetable foods花粉和蔬菜中的3個(gè)明顯交叉反應(yīng)結(jié)構(gòu),1） Bet v l is the major birch pollen allergen Bet v 1是主要的樺樹花粉過敏原 Allergens with cross-reactivity to Bet v 1 ： 與Bet v 1有交叉反應(yīng)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）Profilins are widely distributed in the plant kingdom and have been identified as plant pan Allergens. Profilin廣泛分布在植物王國(guó)，被稱為“植物pan過敏原” 10 to