食物过敏史。

Chemical immunology and allergy Pub Date : 2014-01-01 Epub Date: 2014-05-22 DOI:10.1159/000358616
Brunello Wüthrich
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引用次数: 15

摘要

在这一章中,我们将首先考虑在古代文献的基础上,是否有真正的证据表明,在食物摄入后的致病反应可能与过敏相当,例如在希波克拉底或卢克莱修的经文中。在这个话题上,我们持怀疑态度,这与医学历史学家Hans Schadewaldt的观点一致。我们还断言,在医学文献中,国王理查德三世不太可能是第一个食物过敏的个体。最有可能的是,这并不是精心策划的草莓中毒(“过敏”),而是一种先天缺陷(“……他的伤害从他出生起就如此”),这使得护国公把伊利公爵带到伦敦塔的断头台上,正如我们在托马斯·莫尔(Thomas More, 1478-1535;由他的女婿拉斯特尔于1557年出版)。1912年,美国儿科医生奥斯卡·门德森·施洛斯(Oscar Menderson Schloss, 1882-1952)可能是第一个将抓痕试验用于诊断食物过敏的人。进一步讨论了食物过敏实际诊断中的里程碑,包括抓痕试验、皮内试验、改良点刺试验和刺对刺试验。根据Max Werner(1911-1987)的说法,假阴性结果可归因于“突变反应”现象,或者归因于食品的发酵降解。免疫球蛋白E的发现标志着过敏诊断的一个转折点,在1967年引入放射性过敏吸收试验之前,几种或多或少可靠的技术被用于食物过敏的诊断,如根据Coca进食后脉搏率增加,白细胞减少指数,嗜碱性粒细胞下降或血小板急剧减少。“白细胞毒性测试”(布莱恩测试),今天被称为“ALCAT”测试,没有科学依据。双盲安慰剂对照食物刺激试验仍然是诊断食物过敏的黄金标准。对于未来,使用重组分子过敏原或芯片阵列(如ISAC技术)进行组件解析诊断,前景广阔。关于临床情况,给出了一个主观的选择,涉及花粉相关的食物过敏(“桦树-艾草-芹菜-香料综合征”),以及自20世纪80年代以来出现的致命食物过敏的新现象。最后,Erich Fuchs(1921-2008)首次描述的引发“衍生性过敏”的罕见方式,例如接吻,以及“口腔过敏综合征”和口腔低敏化也被考虑在内。
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History of food allergy.

In this chapter we will first consider whether there is real evidence on the basis of literature for early descriptions in antiquity of pathogenic reactions after food intake that could be comparable to allergy, for instance in the scriptures of Hippocrates or Lucretius. On this topic we are skeptical, which is in agreement with the medical historian Hans Schadewaldt. We also assert that it is unlikely that King Richard III was the first food-allergic individual in medical literature. Most probably it was not a well-planned poisoning ('allergy') with strawberries, but rather a birth defect ('… his harm was ever such since his birth') that allowed the Lord Protector to bring Mylord of Ely to the scaffold in the Tower, as we can read in The History of King Richard III by Thomas More (1478-1535; published by his son-in-law, Rastell, in 1557). In 1912, the American pediatrician Oscar Menderson Schloss (1882-1952) was probably the first to describe scratch tests in the diagnosis of food allergy. Milestones in the practical diagnosis of food allergy are further discussed, including scratch tests, intradermal tests, modified prick tests and prick-to-prick tests. False-negative results can be attributed to the phenomenon of a 'catamnestic reaction' according to Max Werner (1911-1987), or to the fermentative degradation of food products. Prior to the discovery of immunoglobulin E, which marked a turning point in allergy diagnosis, and the introduction of the radioallergosorbent test in 1967, several more or less reliable techniques were used in the diagnosis of food allergy, such as pulse rate increase after food intake according to Coca, the leukopenic index, drop in basophils or drastic platelet decrease. The 'leukocytotoxic test' (Bryan's test), today called the 'ALCAT' test, shows no scientific evidence. The double-blind placebo-controlled food challenge test remains the gold standard in the diagnosis of food allergy. For the future, component-resolved diagnostics with the use of recombinant molecular allergens or chip arrays, such as the ISAC technique, hold a lot of promise. With regard to the clinical situation, a subjective selection is given, touching on the pollen-associated food allergies ('birch-mugwort-celery-spice syndrome'), as well as the new phenomenon of lethal food allergies that have appeared since the 1980s. Finally, rare ways of elicitation of a 'derivative allergy', first described by Erich Fuchs (1921-2008), for example by kissing, as well as 'oral allergy syndrome' and oral hyposensitization are considered.

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Historical background, definitions and differential diagnosis. Immunological basis of food allergy (IgE-mediated, non-IgE-mediated, and tolerance). Food allergens: molecular and immunological aspects, allergen databases and cross-reactivity. Epidemiology: international point of view, from childhood to adults, food allergens. Food allergy in childhood (infancy to school age).
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