diaignosis alergi blok 20 maret 2014
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*Diagnostic Tools of Food AllergySumadionoPediatric Department Fac. of Medicine Gadjah Mada University Yogyakarta
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Food Allergy Diagnosis StepsAllergy HistoryClinical Signs and SymptomsSkin Test (skin prick test, atopy patch test)Specific IgE test (RAST)Elimination & Provocation test
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Unproven methods: Procedures used in diagnosis and treatment that lack scientific credibility.
Have not been shown to have clinical efficacy
Commercial interests
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Invalid tests
Cytotoxic testingplacing a drop of the persons blood onto a glass microscope slide which has a spesific dried food already attached to the glass.
Provocation-Neutralizationinjecting a various chemicals, pollens, food, hormone or toxins into the skin of person results any symptom = provocation dose.Smaller doses and concentrations of that same substances are injected until no symptoms occur = neutralization dose.
More D,MD. Controversial and Unproven Tests in the Diagnosis of Allergies. 2011
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Invalid tests Electrodermal Diagnosis
Diagnose food or other allergies through changes in skin resistance by measuring an electric current. The person will hold a glass vial containing the food in question in one hand, and source of electrical current in the other hand.
More D,MD. Controversial and Unproven Tests in the Diagnosis of Allergies. 2011
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Invalid tests Electrodermal Skin Test VEGA test - Bioresonance
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Invalid tests Applied Kinesiology detection a change in a persons muscle strenght
Reaginic Pulsemeasures a persons pulse after eating a particular food.
Body Chemical Analysistrace amount of chemicals measured in body fluids, hair and tissue that can leads to allergy symptoms and disease.More D,MD. Controversial and Unproven Tests in the Diagnosis of Allergies. 2011
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Food Allergy Diagnosis StepsAllergy HistoryClinical Signs and SymptomsSkin Test (skin prick test, atopy patch test)Specific IgE test (RAST)Elimination & Provocation test
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Food allergy: clinical manifestations IgE IgE/Non-IgE Non-IgEUrticaria/angioedemaRhinitis /AsthmaAnaphylaxis
Oral allergic syndromeGastrointestinal symptoms
Atopic dermatitis
Eosinophilic gastro-intestinaldisordersProtein-induced proctocolitis/enterocolitis
Celiac diseaseContact dermatitisHerpetiform dermatitis
Adapted from J Allergy Clin Immunol. 1999;103:717-728
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Generally begins in early infancy Characterized by typical distribution, extreme pruritus, and chronically relapsing courseCutaneous food hypersensitivities:atopic eczema
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Acute Urticaria and Angioedema:The most common symptoms of food allergic reactions
Chronic Urticaria:Food allergy is an infrequent cause of chronic urticaria and angioedemaCutaneous food hypersensitivities
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IgE mediated: respiratory manifestations
AsthmaAn uncommon manifestation of food allergyUsually seen with other food-induced symptoms
RhinoconjunctivitisUsually seen during positive controlled challenge tests, but occasionally reported by patients
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IgE Mediated: systemic reactionanaphylaxis/anaphylaxis syndrome Food-induced anaphylaxis - Rapid-onset - Multi-organ system involvement - Potentially fatal - Any food, highest risk: peanut, nut, seafood, milk, egg
Food-dependent - exercise-induced - Associated with a particular food - Associated with eating any food
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An immediate reaction (1- 2 hours) is suggestive of an IgE mediated reaction to foods Diagnosing IgE-mediated food hypersensitivity disordersMedical history: Timing of reactionAdapted from Adverse Reactions to Foods Committee, Spanish Society of Allergy and Clinical Immunology Alergol Inmunol Clin 1999; 14: 50-62.
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Allergens eliciting a wheal of at least 3 mm greater than the negative control
Overall positive predictive accuracy is 50 %Negative predictive accuracy > 95 %Diagnosing IgE-mediated food hypersensitivity disorders+Diameter 3 mm
Skin Prick Test
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Prick: Reproducible, sensitive, not irritantPrick-prick: Use raw or cooked food. Highly recommended for fruits and vegetables (commercially prepared extracts are generally inadequate because of the lability of the allergens, so the fresh food must be used for skin testing)Diagnosing IgE-mediated food hypersensitivity disorders Skin tests
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Impracticality of skin testingSkin disorder, drug inhibition, uncooperatvie patients
Prevention of systemic reactionsPrior history of anaphylactic reaction, severe asthma,
Convenience
DisadvantagesCost, Results delayed
IgE SpecificRadioimmunosorbant Assay (RAST)
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Diagnosis: elimination diets and food challengesElimination diets (1 - 6 weeks): - Eliminate suspected food/s, or - Prescribe limited eat only diet, or - Elemental diet
Oral challenge testing: - Physician supervised - Emergency room medications must be available
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Oral Challenge TestChallengeRecord baseline symptomsEat and average portion of the pure food within 5 minutesRecord symptoms over the 1st hourMay repeat a feeding in no symptoms in the 1st hourObserve patient a minimum of 2 hours
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*Atopy Patch Test (APT)Vivo
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- Elimination & Provocation TestSpecific IgEElimination & Provocation Test - Atopy Patch Test
- Endoscopy, Biopsy of Gut, Skin
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THANK YOU
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