食品敏感性、過(guò)敏性反應(yīng)和食品不耐性

FoodSensitivities,AllergicReactions,andFoodIntolerances

食品敏感性、過(guò)敏性反響和食品不耐性CONTENTS主要內(nèi)容DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION

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

第二節(jié)食品不良反響的病癥DIAGNOSISOFADVERSEFOODREACTIONS

第三節(jié)食品不良反響的診斷法PREVALENCE

第四節(jié)發(fā)病率FOODALLERGENS

第五節(jié)食品過(guò)敏原FOODADDITIVES

第六節(jié)食品添加劑FOODLABELINGINRELATIONTOFOODSENSITIVITIES

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

第一節(jié)食品不良反響的定義和機(jī)理

Fig.1ClassificationoffoodsproposedbyEAACI圖1EAACI對(duì)食品的分級(jí)toxicfoodreactions食品毒性反響Aclassicaltoxicfoodreactionisscombroidfishpoisoning,duetolargeamountsofhistamine鯖亞目魚(yú)組胺中毒是典型的食品毒性反響。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)食品不良反響的病癥IgE-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.皮膚呼吸道胃腸道心臟血管系統(tǒng)

45%25%20%10%Figure2ClassicalsymptomsofIgE-mediatedfoodailergy圖2以IgE為媒介的食品敏感綜合癥分布OralAllergySyndrome

〔一〕口腔敏感綜合病癥Allergen:freshfoods(fruitsandvegetables)過(guò)敏原：新鮮食品〔如水果和蔬菜〕Symptom病癥：Itchingofthelips,mouth,palate，throat嘴唇、嘴、上腭咽喉等處立即發(fā)癢Hoarsenessand/orswellingofthelips,tongue,uvula,andlarynx嗓音嘶啞，嘴唇、舌頭、小舌、喉等腫脹AllergicReactionsAfterIngestionofFood

〔二〕攝入食品后的過(guò)敏反響Symptom病癥：1〕Themainsymptomsofgastrointestinalfoodallergyarevomiting,nausea,diarrhea,andabdominalpains(colicsorcramps).胃腸道主要病癥:嘔吐、反胃、腹瀉以及腹部疼痛〔絞痛或痛性痙攣〕；2)Skinreactionsincludelocalorgeneralizedpruritus,flush,urticaria,angioedema.morbilliformexanthema,andflare-upofatopicdermatitis皮膚反響：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)Thesymptomsoftheupperandthelowerrespiratorytractarerhinitis(sneezing,pruritusofthenose,nasalstuffiness,andnasalobstruction),larynxedema,cough,wheezing,andbronchialasthma.上呼吸道或稍低些的呼吸道病癥：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,andwateringeyes(conjunctivitis)發(fā)癢、充血以及眼睛流淚〔結(jié)膜炎〕.AllergicReactionsAfterInhalationofFood

〔三〕吸入食品后的過(guò)敏反響

Symptom病癥：respiratorysymptoms呼吸道綜合癥Allergen:flour,n-amylase,greencoffee,castorandsoybeans,spices.eggwhite,andcrustaceans過(guò)敏原：面粉、α-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AllergicReactionsFollowingSkinContactWithFood

〔四〕皮膚接觸食品后的過(guò)敏反響Allergen:fish,shrimp,flour,andpork過(guò)敏原：魚(yú)、小蝦、面粉和豬肉

Symptom病癥：Urticariallesion風(fēng)疹Chroniccontactwithafoodmayinduceproteincontact,dermatitisinfoodhandlers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-MediatedImmuneReactions

二、不以IgE為媒介的免疫反響Heiner'sSyndrome,AllergicAlveolitis,andHemorrhagicGastroenteritisinChildhood

〔一〕兒童Heiner綜合癥、過(guò)敏性齒槽炎、出血性腸胃炎DEFINITION：ThetermHeiner'ssyndromecharacterizesamilk-inducedsyndromewithpulmonarydiseaseininfants.Heiner綜合癥：嬰兒因牛奶誘導(dǎo)的肺病

Symptom病癥：chronicorrecurrentpulmonaryintiltrates慢性或周期性發(fā)生的肺滲透allergicalveolitis過(guò)敏性齒槽炎achronicrhinitis慢性鼻炎gastrointestinalbloodloss腸胃失血癥irondeficiencyanemia缺鐵性貧血chroniccough慢性咳嗽recurrentfever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：institutionofamilk-freediet飲食中去除牛奶Gluten-SensitiveEnteropathy(CeliacDisease)

〔二〕谷蛋白敏感性腸病〔乳糜瀉〕Definition：damagetothesmallintestinalmucosaandsymptomsofmalabsorption定義：小腸黏膜損傷和吸收不良病癥小腸黏膜損傷和吸收不良病癥Allergen過(guò)敏原：Gliadin麥醇溶蛋白presentinwheat,rye,barley,andoat廣泛存在于小麥、燕麥、大麥和黑麥中Thepeakincidenceofsymptomsisininfancyaftertheintroductionofcereals;嬰兒開(kāi)始添加谷物類食物時(shí)最容易發(fā)生這類病癥，為第一頂峰期；Asecondpeakoccursduringthethirddecade.第二頂峰期發(fā)生在三十歲。Symptom病癥：abdominalpain周期性腹部疼痛loosestools便溏anorexia厭食shortstature體態(tài)短小delayedpuberty青春期滯緩nutritionaldeficiencies吸收不良Dentalenamelhypoplasia牙科瓷發(fā)育不全recurrentaphthae周期性口瘡Control控制措施：Patientswithceliacdiseasemustavoidgliadinsandrelatedproteinspermanently遠(yuǎn)離麥醇溶蛋白以及相關(guān)蛋白質(zhì)DermatitisHerpetiformis〔三〕皰疹樣皮炎Definition定義：chronicblisteringdisease一種慢性起皰疾病

Symptom病癥：itchy發(fā)癢sometimesburning有時(shí)有灼傷感eruptionofgroupedvesiclesonanerythematousground在紅斑狀范圍內(nèi)出現(xiàn)成群泡樣出疹SomeDHpatients,evenwithoutgastrointestinalsymptoms,mayhavevillousatrophysimilartothatseeninceliacdisease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。Thecutaneousmanifestationsmayormaynotrespondtoagluten-freediet飲食中排除麥醇溶蛋白可能會(huì)、也有可能不會(huì)改善皮膚病癥。EosinophilicGastroenteritis

〔四〕嗜酸性胃腸炎Definition定義：elevatedeosinophilcountsinbloodandtissueeosinophiliawithreleaseofeosinophiimajorbasicprotein釋放嗜曙紅細(xì)胞主要根本蛋白質(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Clinicalmanifestations臨床病癥：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foodhypersensitivityhasbeensuggestedEG可能由食品超敏性引起UtcerativeColitis

〔五〕潰瘍性結(jié)腸炎Definition定義：aninflammatoryboweldiseaseofunknownorigin一種不明起因的炎癥性腸病

NoadversefoodreactionshavebeenshownascausativeofUC還不能證明食品不良反響會(huì)造成UCAllergicVasculitis

〔六〕變應(yīng)性脈管炎Cause起因：foodsandfoodadditives食品及其添加劑Symptom病癥：allergicpurpura(widespreadhemorrhagicmaculesandpapules,mainlyonthelowerlegs)demonstratedbysinglechallenges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〕FoodIntolerance

三、食品不耐性

LactaseDeficiency

乳糖酶缺乏綜合征

Definition定義：Lackoftheenzymethatcleavesmilksugar,lactose,givesrisetoadversereactionswhenlactoseisconsumed.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)生不良反響Theonlyfoodofwhichlactoseisanaturalconstituentismilk(3.7g/100mlcowsmilk).天然含乳糖的唯一食品是牛奶〔3.7g/ml牛奶〕Classification分類：1〕congenitallactasedeficiency先天性乳糖酶缺乏綜合征2〕primarylactasedeficiency初級(jí)的乳糖酶缺乏綜合征3〕secondarylactasedeficiency二級(jí)乳糖酶缺乏綜合征1〕congenitallactasedeficiency先天性乳糖酶缺乏綜合征lactaseisnotpresentandsymptomswillappearwhenthepatientisbreast-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Thecongenitalformisveryrare這種病癥極少見(jiàn)2〕primarylactasedeficiency初級(jí)的乳糖酶缺乏綜合征seeninmostoftheworld'spopulationwheretheproductionoflactasedecreasesordisappearsfromtheageof2totheteenageyears在2-10歲時(shí)，乳糖酶分泌下降或消失Persistenthighlactaseactivityinadultlifeoccursamongrelativelyfewethnicgroups:成年人體內(nèi)乳糖酶活性一直處于頂峰的人群：northernEuropeansandtheiroverseasdescendants北歐以及沿海后代afewAfricangroupsofpastoraltraditionBedouinsandotherSaudiArabs一些源于牧人的非洲人、貝都因人和沙特阿拉伯人certaingroupsfromwestIndiaandPakistan西印度和巴基斯坦局部人群3〕secondarylactasedeficiency二級(jí)乳糖酶缺乏綜合征aconsequenceofpathologicalchangesinthegutmucosa,asseeninceliacdiseaseorinflammations.乳糜瀉或炎癥引起內(nèi)臟黏膜病變的結(jié)果

Whenthegutmucosahasregaineditsnormalappearancethelactaseproductionreappears當(dāng)內(nèi)臟黏膜恢復(fù)正常，乳糖酶也開(kāi)始重新分泌。Thesymptoms病癥：Diarrhea腹瀉gasproduction產(chǎn)氣Colic絞痛Control控制措施：avoidallproductscontainingevensmallamountsoflactose防止食用任何含乳糖的食品PREVALENCE

第四節(jié)

發(fā)病率

Thetotalprevalenceoffoodallergy/foodintoleranceisnotknown.總發(fā)病率未知Estimatesbasedondatafromonecountrydonotnecessarilyreflecttheprevalenceofanothercountry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?〕frequencyanddurationofbreastfeeding母乳喂養(yǎng)的頻率和持續(xù)時(shí)間2〕eatinghabits飲食習(xí)慣3〕flora植物群Children

一、兒童

Food

〔一〕食品allergytocow'smilk,egg,andfishpredominantlybeginsbeforethesecondyearofage對(duì)牛奶、雞蛋和魚(yú)的過(guò)敏性主要發(fā)生2歲以前allergytofruit,legumes,andvegetablespredominantlybeginsafterthesecondyear.對(duì)水果、豆類和蔬菜的過(guò)敏性主要發(fā)生在2歲以后

Table1PrevalenceofRhinitisandOralItchinDanishSchoolChildren丹麥學(xué)齡兒童中鼻炎和口腔發(fā)癢的發(fā)病率Age(yr)Rhinitis(%)Oralitch〔%)boys/girls boys/girls5-79.0/5.7 0/0.3

8-108.5/7.1 0.8/1.1

11-1314.0/8-5 1.9/1.5

14-1617.3/13.0 2.9/2.0FoodAdditives

〔二〕食品添加劑Adversereactionstofoodadditivesarefoundin1-2%ofschoolchildren1-2%學(xué)齡兒童對(duì)食品添加劑有不良反響Theprevalenceinyoungerchildrenisnotknown.至今不知小年齡兒童的發(fā)病率Adults

二、成年人

Food

〔一〕食品InEuropeanstudiesthemajorityofallergicfoodreactionsinadultsarecausedbyfruits.vegetables,andnutsandarerelatedtopollenallergy在歐洲，大局部成年人食品過(guò)敏性反響是由水果、蔬菜和堅(jiān)果引起的，且與花粉過(guò)敏癥有關(guān)Theprevalenceisaround5%發(fā)病率在5%左右probablyonly0,5%havesymptomsotherthanoralitch.大約只有0.5%不是口腔發(fā)癢病癥Theprevalenceofallergytomilk,egg,fish.etc.isaround0.2%，，牛奶、雞蛋、魚(yú)等引起的過(guò)敏癥發(fā)病率大約為0.2%FoodAdditives

〔二〕食品添加劑Theestimatedfrequencywas0.03-0.15%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%InBritish：theprevalence大不列顛人：發(fā)病率為0.026%Dutch丹麥：0.4%ContactAllergens

〔三〕接觸性過(guò)敏原10%Danishwomenhavecontactallergycausedbynickel.10%丹麥婦女因鎳造成接觸性過(guò)敏癥Upto10%ofthesemaybenefitfromanickel-restricteddiet其中10%以上會(huì)因排除鎳的飲食而改善Whatiscontactallergens？Indermallysensitizedsubjectsingestionofthecontactallergenmaycauseskinflarereactionsorothersymptoms,e.g.,inthegastroinlestinaltract皮膚敏感癥受檢者攝入接觸性過(guò)敏原后會(huì)導(dǎo)致皮膚潮間帶反響或胃腸道病癥等其他病癥。ContactAllergens：fragrances芳香物質(zhì)foodflavors〔naturalorsynthetic〕食品風(fēng)味物Nickel鎳

OtherAdverseReactions〔四〕其它不良反響1〕Celiacdisease腹部疾病：Cause：wheatgliadinandrelatedproteins起因：小麥麥醇溶蛋白和相關(guān)蛋白質(zhì)Theprevalence：0.2-0.5%發(fā)病率：0.2-0.5%2〕lactasedeficiency乳糖酶缺乏綜合征Cause：Lackoflactase起因：缺乏乳糖酶Theprevalence：variesfromafewpercentinnorthernEuropeancountriestoalmosttheentireadultpopulationinAsiaandAfrica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：Itisnotknownwhethertheprevalenceoffoodallergyorintoleranceisincreasing不清楚食品過(guò)敏/不耐性的發(fā)病率是否有上升趨勢(shì)Theprevalenceofpollen-relatedfoodallergieshasincreased.與花粉相關(guān)食品敏感癥的發(fā)病率在提高。FOODALLERGENS

第五節(jié)

食品過(guò)敏原

Definition定義Allergensareantigensthatgiverisetoallergy.過(guò)敏原是能引起敏感的抗原Whereisfoodallergensfrom？Pollen花粉Mammals哺乳動(dòng)物mites螨otherinsects其他昆蟲(chóng)foods食品Component：過(guò)敏原成分：Proteinsorglycoproteinswithamolecularweightfrom3to90kDa,themajorityrangingfrom10to40kDa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，大局部在10kDa到40kDa之間Theidentifiedallergens：thefirstthreelettersofthegenus,space,thefirstletterofthespecies,space,andanArabicnumber.XXXXX屬種阿拉伯?dāng)?shù)字Forexample：Lolp1referstothefirstpollenallergenidentifiedfromLoliumperennc,orryegrassLolp1表示第一個(gè)花粉過(guò)敏原，來(lái)自Loliumperenne或黑麥草Classification分類"major"：proteinsforwhich50%ormoreoftheallergicpatientsstudiedhavespecificIgE“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“：theremainingallergensareconsideredminor“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)TheNatureofFoodAllergens

一、過(guò)敏原的種類

Tomakeacompletelistofallergenicfoodsonaglobalbasisisvirtuallyimpossible.我們不可能列出一張食品過(guò)敏原清單Whetherafoodallergencausessignificantproblemsinapopulationisdependentonseveralfactors：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：

〔a〕thepotencyoftheallergen

過(guò)敏原的效能somearemuchmorefrequentsensitizerslhanothers有些抗體比其他抗體造成敏感癥的次數(shù)更多，e.g.,β-lactoglobulininmilkorovomucoidfromeggwhite如：牛奶中的β-乳球蛋白或雞蛋蛋白中的卵類粘蛋白〔b〕thephysiochemicalproperties

物化性質(zhì)：1〕Thechemicalstructure,i.e.,theaminoacidsequence,andthetertiarystructure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〕heatstability熱穩(wěn)定性3〕digestibility可消化性4〕Structuralrelationshipwithepitopesfromnonfoodallergens非食品過(guò)敏原與抗原決定族之間的結(jié)構(gòu)關(guān)系〔c〕thefrequencyofexposure

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

暴露途徑1〕aero-allergens：grasses,pollenoftreesandherbs，housedustmites，ocatdander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〕workenvironment：baker工作環(huán)境：面包工人3〕viatheskin：Naturalrubber(latex)通過(guò)皮膚：天然橡膠〔e〕cross-reactionstoaero-allergens

飛散過(guò)敏原的交叉反響1)localspeciesofgrass,trees,andherbsandpollution當(dāng)?shù)厣L(zhǎng)的草、樹(shù)以及藥草種類e.g.,Allergytohazelnutsiscommoninareaswithmanybirchtrees,wherebirchpollenhayleverisfrequent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)airpollution空氣污染

(f)theageatwhichtheallergenisintroduced

受過(guò)敏原入侵的個(gè)體年齡Inearlyinfancyanincreaseduptakeofantigentakesplaceatatimewhenthegut-associatedlymphoidtissueisstillincompletelydeveloped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。AllergensofAnimalOrigin

二、來(lái)源于動(dòng)物的過(guò)敏原

Milk〔一〕牛奶1〕Albumin,β-lactoglobulin,andimmunoglobulinsofmilkarethemostimportantallergensininfants嬰兒：清蛋白、β-乳球蛋白和免疫球蛋白2〕Inolderchildrenβ-lactoglobulin,caseins,andI-lactalbuminmaybemorereactive.大孩子：β-乳球蛋白、酪蛋白和?-乳白蛋白3〕inadulthood：caseintobethemostfrequentallergen成人期：酪蛋白cross-reactions交叉反響Themajorityofpatientswithallergytocow'smilkproteinswillalsoreacttoproteinsfromsheep'sandgoat'smilk大局部對(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-reactionsbetweenmilkfromthesespeciesisnotalwayspresent.各種奶之間的交叉反響并不一直存在Eggs

〔二〕雞蛋thesecondmostfrequentfoodallergeninsmallchildrenaftercow'smilk在小孩子中大概是僅次于牛奶的食品過(guò)敏原

Eggwhiteproteinsarereportedtoelicitallergicreactionsmorefrequentlythaneggyolk.雞蛋蛋白比蛋黃更易引起過(guò)敏反響蛋黃中的主要過(guò)敏原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交叉反響:allergytoeggcanbecorrelatedtoallergytobirdfeathers雞蛋敏感癥與鳥(niǎo)類羽毛敏感癥之間有相關(guān)性themajorcross-reactingdeterminantsarethelivetinsfromeggyolk.主要交叉反響的決定因素是蛋黃中的卵黃蛋白AllergensofPlantOrigin

三、來(lái)源于植物的過(guò)敏原

Thevegetablefoodsthatmostcommonlycausehypersensitivitysymptoms

致敏性蔬菜種類hazelnut榛實(shí)Walnut胡桃Brazilnut巴西堅(jiān)果Apple蘋(píng)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Therankinglistsvarydependingon

各種蔬菜致敏程度的影響因素1〕theageofthepatients病人的年齡2〕themethodsofdiagnosis診斷方法以及3〕thegeographiclocationofthepopulation地理環(huán)境Fruits,Nuts,andVegetables

〔一〕水果、堅(jiān)果和蔬菜Morethan90%ofpatientswithsensitizationtovegetablefoodshadconcomitantsensitizationtopollen90%以上的蔬菜敏感癥總是伴隨著花粉敏感癥而來(lái)

Inagroupofbirchpollenallergiesthepatientswithadditionalhypersensitivitytonutsandappleshad：在一組同時(shí)有另外的堅(jiān)果和蘋(píng)果超敏性的樺樹(shù)花粉敏感癥病人中(1)moreseveresymptomsduringthepollenseason在花粉季節(jié)病癥嚴(yán)重加重(2)highervaluesofIgEtobirchandhazelpollen,樺樹(shù)和榛子花粉的IgE值較高(3)alargerareaoftheskinpricktestreactivetobirchandhazelpollencomparedtothegroupwithoutappleandnutallergy與那些沒(méi)有堅(jiān)果和蘋(píng)果超敏性病人相比，樺樹(shù)和榛子花粉的皮膚穿刺試驗(yàn)反響區(qū)域要大得多。Thesymptoms主要病癥：Mainlyfromthemouthandpharynx,withitching,swellingofthelips,tongue,andthroat.syndrome.從嘴到咽發(fā)癢，嘴唇、舌頭以及咽喉腫脹Thesesymptomsarecalledthe“oralallergy〞“口腔敏感綜合癥〞cross-reactions交叉反響:1〕Asensitizationtomugwortpollensanddifferentspices,theso-calledmugwort-celery-spicessyndrome,hasbeenreported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〕Itwasshownbyprick,RASTstudies,andRASTinhibitionexperiments皮膚穿刺、RSAT研究以及RSAT抑制實(shí)驗(yàn)證明：acelery-thermolabileallergenseemstobeinvolvedincelery-birch-pollen-allergicpatients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athermostableallergenisinvolvedincelery-mugwort-allergicpatients.一種耐熱過(guò)敏原會(huì)導(dǎo)致芹菜-艾蒿敏感癥Pollen-relatedfoodallergiesarethoughttobecausedbycross-reactionsofpollen-specificIgEantibodieswithepitopesoffoodproteins.花粉特異IgE抗體與食品蛋白質(zhì)的抗原決定族發(fā)生交叉反響，導(dǎo)致了花粉相關(guān)食品敏感癥Threedistinctcross-reactivestructuresinpollenandvegetablefoods

花粉和蔬菜中的3個(gè)明顯交叉反響結(jié)構(gòu)1〕BetvlisthemajorbirchpollenallergenBetv1是主要的樺樹(shù)花粉過(guò)敏原Allergenswithcross-reactivitytoBetv1：與Betv1有交叉反響的過(guò)敏原有：Apples蘋(píng)果Hazelnuts榛實(shí)cherries櫻桃Pears梨子Celery艾蒿

carrots胡蘿卜2〕Profilinsarewidelydistributedintheplantkingdomandhavebeenidentifiedas"plantpanAllergens."Profilin廣泛分布在植物王國(guó)，被稱為“植物pan過(guò)敏原〞10to20%ofthepollen-allergicpatientsaresensitizedtopronlins.10-20%花粉敏感病人對(duì)profilins敏感3〕Cross-reactionsofallergen-specificIgEantibodiescanbecausedbyso-called"cross-reactivecarbohydratedeterminants"offoodandpollenglycoproteins.食品和花粉糖蛋白，又稱為“交叉反響碳水化合物決定物〞會(huì)引起過(guò)敏原與特異性IgE抗體的交叉反響。Cereals

〔二〕谷物twomajorallergens：兩個(gè)主要過(guò)敏原IgE：oneat47kDaoneat20kDaWhenchallengedwithdouble-blind,placebo-controlledfoodchallengeDBPCFC實(shí)驗(yàn)證實(shí)21%ofthepatientswithsuspectedallergytocerealshadsymptoms21%谷物過(guò)敏兒童有綜合病癥8%hadclinicalreactionstoonlyonecereal8%兒童只對(duì)一種谷物有臨床反響Themajorityofthechildrenhadclinicalreactionstowheat(76%)大局部?jī)和?6%〕對(duì)谷物有臨床反響Legumes〔三〕豆類PeanutallergymaybethemostcommonfoodallergyintheUnitedStates在美國(guó)，花生敏感癥是最常見(jiàn)的食品敏感癥Allergicreactionsareoftenacuteandsevere過(guò)敏反響經(jīng)常是急性和嚴(yán)重的Themajorpeanutallergen：主要的花生過(guò)敏原：

glycoprotein糖蛋白Arah1，molecularweightof66kDaArah2,molecularweightof17kDa{Thecharacteristic特征：heatstable熱穩(wěn)定性apotentialsourceof"hiddenfoodallergens一種“隱藏性食品過(guò)敏原〞的潛在資源NaturalRubber(Latex)-RelatedFoodAllergens

〔四〕與天然橡膠〔乳膠〕有關(guān)食品過(guò)敏原

Thelatexallergensareproteinsfromtherubbertree乳汁過(guò)敏原是來(lái)自橡膠樹(shù)的蛋白質(zhì)

Commonantigenicdeterminantsdemonstratedbetweenlatexandavocado,chestnut,andbanana乳汁與鱷梨、栗子和香蕉之間存在共同的抗原定子Allergytonaturalrubber(latex)hasbecomeincreasinglyproblematic天然橡膠〔乳汁〕敏感癥有上升趨勢(shì)Thesereactionsaresevere,e.g.,anaphylacticshock許多反響是嚴(yán)重的，如過(guò)敏性休克FOODADDITIVES

第六節(jié)

食品添加劑

Chemicallyandfunctionallyfoodadditivesareaveryheterogeneousgroupofsubstancesconsistingof：化學(xué)性的和功能性的食品添加劑的組成：

Enzymes酶Flavors風(fēng)味物Colors色素Preservatives防腐劑

Emulsifiers乳化劑Antioxidants抗氧化劑Sweeteners甜味劑

Colors

一、色素

AzoColors

〔一〕含氮色素Theazocolorscauseadversereactions:會(huì)造成不良反響的含氮色素：tartrazine酒石黃sunsetyellow落日黃azorubin/carmoisin偶氮玉紅amaranth莧菜紅ponceau4R麗春紅4RSymptoms:mainlyontheskinandmainlyurticaria主要病癥：皮膚風(fēng)疹Tartrazinehasbeentheadditiveofchoicewhenresearchershavetriedtoelucidatethemechanismoffood-additiveintolerance酒石黃作為機(jī)理實(shí)驗(yàn)物apharmacologicaleffectoftartrazineandotherazocolors酒石黃和其他含氮色素具有藥物學(xué)影響pharmacologicaleffect：藥物學(xué)影響：alargecumulativedoseoftartrarine(200mg)innormalsubjectsresultedinasignificantriseinplasmaandurinaryhistaminelevels.患者體內(nèi)酒石黃積累到很高濃度時(shí)，血漿和尿液中組胺濃度明顯升高Thehistaminereleasewasnotaccompaniedbysystemicsymptoms全身組織綜合病癥導(dǎo)致組胺不能完全釋放出來(lái)Nonazocolors

〔二〕無(wú)氮色素Nonazocolorscouldgiveadversereactions:會(huì)造成不良反響的無(wú)氮色素：Annatto果紅Indigo靛藍(lán)Carmine胭脂紅Erythrosine赤蘚紅patentblue專利藍(lán)(三苯甲烷系染料〕Symptoms:mainlyontheskinandmainlyurticaria主要病癥為皮膚風(fēng)疹Preservatives

二、防腐劑

BenzoicandSorbicAcid

〔一〕安息香酸和山梨酸causesofurticaria造成接觸性風(fēng)疹provokeitchingandtinglinginthemouth出現(xiàn)口腔發(fā)癢和麻刺感Themechanismisnotknown其致病機(jī)制未知Sulfites

〔二〕亞硫酸鹽symptoms病癥：asthma哮喘anaphylacticreactions皮膚過(guò)敏symptomsontheskin皮膚綜合癥thelikelihoodofareactiondependon：

致敏反響的可能性取決于：Thenatureofthefood食品的特性thelevelofresidualsulfite亞硫酸鹽的殘留水平thesensitivityofthepatient病人的敏感性theformofresidualsulfite亞硫酸鹽的殘留形式themechanismofthesulfite-inducedreaction亞硫酸鹽誘導(dǎo)反響機(jī)理thecauseofasthmaticreactionstosulfltesinfood

亞硫酸鹽哮喘反響的原因：inhalationofsulfurdioxideliberatedduringingestion食用時(shí)吸入了二氧化硫deficiencyofsulfiteoxidase缺乏亞硫酸鹽氧化酶Metabisulfite偏亞硫酸氫鈉Metabisulfite-inducedbasophilhistaminereleaseinanonasthmaticpatient偏亞硫酸氫鹽具有誘發(fā)嗜堿細(xì)胞釋放組胺的功能developedurticariaandangioedemafollowingprovocationwithsodiummetabisulfite偏亞硫酸氫鈉激發(fā)會(huì)造成風(fēng)疹和血管性水腫anIgE-mediatedreaction偏亞硫酸氫鈉的敏感性是一種以IgE為媒介的反響FlavorEnhancersandFlavors

三、風(fēng)味促進(jìn)劑和香精

FlavorEnhancers:MonosodiumGlutamate

〔一〕風(fēng)味促進(jìn)劑：味精Theresultofmonosodiumglutamate(MSG)wastheChineserestaurantsyndrome(CRS)andasthma。味精會(huì)造成：中國(guó)餐館綜合癥〔CRS〕喘病癥1〕symptomsofCRS病癥：headache頭痛aburningsensationalongthebackoftheneck沿著脖子背部的灼熱感chesttightness胸悶Nausea作嘔Sweating發(fā)汗SymptomscharacteristicoftheChineserestaurantsyndromecanbeprovokedinalimitednumberofindividuals