食品安全5

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,FoodSensitivities,Allergic Reactions,and Food Intolerances食品敏,感,感性、过敏,性,性反应和食,品,品不耐性,CONTENTS 主,要,要内容,DEFINITIONANDMECHANISMSOF ADVERSE FOOD REACTION,第,第一节,食,食品不良反,应,应的定义和,机,机理,SYMPTOMS OF ADVERSEFOODREACTIONS,第,第二节 食,品,品不良反应,的,的症状,DIAGNOSISOF ADVERSEFOODREACTIONS,第,第三节食品不良反,应,应的诊断法,PREVALENCE,第,第四节,发,发病率,FOODALLERGENS,第,第五节 食,品,品过敏原,FOODADDITIVES,第,第六节 食,品,品添加剂,FOODLABELING IN RELATIONTO FOOD SENSITIVITIES 第,七,七节 与食,品,品过敏性有,关,关的食品标,签,签,DEFINITIONANDMECHANISMSOF ADVERSE FOOD REACTION,第一节 食,品,品不良反应,的,的定义和机,理,理,Fig.1ClassificationoffoodsproposedbyEAACI,图1EAACI,对,对食,品,品的,分,分级,toxicfoodreactions,食品,毒,毒性,反,反应,Aclassicaltoxicfoodreactionisscombroidfishpoisoning,duetolargeamountsofhistamine,鲭亚,目,目鱼,组,组胺,中,中毒,是,是典,型,型的,食,食品,毒,毒性,反,反应,。,。,Foodintolerance,食,食,品,品不,耐,耐性,enzymatic,(resultingfromanenzymaticdefect,e.g.,lactasedeficiency),“,酶,酶促,性,性的,”,”（,因,因酶,缺,缺陷,造,造成,，,，如,乳,乳糖,酶,酶缺,乏,乏症,）,）,pharmacological,(dependingonthedirecteffectof,e.g.,vaso-activeaminesnaturallyfoundinfoods),“,药,药,理,理,学,学,的,的,”,”,（,（,取,取,决,决,于,于,直,直,接,接,效,效,应,应,，,，,如,如,食,食,品,品,中,中,天,天,然,然,存,存,在,在,的,的,血,血,管,管,活,活,性,性,胺,胺,）,）,“Undefined,不,不,明,明,确,确,的,的,”,”,SYMPTOMSOFADVERSEFOODREACTIONS,第,第,二,二,节,节,食,食,品,品,不,不,良,良,反,反,应,应,的,的,症,症,状,状,IgE-MediatedFoodAllergy,一,、,、,以,以,IgE-,为,媒,媒,介,介,的,的,食,食,品,品,敏,敏,感,感,症,症,Characteristic,特,特征,ClinicalmanifestationsofIgE-mediatedfoodallergy canremainlocalized at thesite of theprimary directcontact,i.e.,一,一直保,持,持在最,初,初的直,接,接接触,部,部位,themouth,嘴,嘴,throat(oralallergysyndrome),咽,咽喉（,口,口腔敏,感,感综合,症,症）,thegastroiniesrinaltract(isolatedgastrointestinalfood allergy)胃肠,道,道（单,独,独的胃,肠,肠道食,品,品敏感,症,症）,SkinRespiratorytractGItractCardievascular S.,皮肤,呼,呼吸道,胃,胃,肠,肠道,心脏血管系,统,统,45%25%20%10%,Figure 2,Classicalsymptoms of IgE-mediatedfoodailergy,图2 以IgE为媒介,的,的食品敏感,综,综合症分布,OralAllergy Syndrome （一,）,）口腔敏感,综,综合病症,Allergen:,freshfoods( fruitsand vegetables),过敏原：,新鲜食品,（,（如水果,和,和蔬菜）,Symptom,症,症状：,Itchingof the lips,mouth,palate，throat,嘴唇、嘴,、,、上腭咽,喉,喉等处立,即,即发痒,Hoarseness and/or swelling of the lips,tongue,uvula, and larynx,嗓,音,音,嘶,嘶,哑,哑,，,，,嘴,嘴,唇,唇,、,、,舌,舌,头,头,、,、,小,小,舌,舌,、,、,喉,喉,等,等,肿,肿,胀,胀,AllergicReactionsAfterIngestionofFood,（,（,二,二,）,）,摄,摄,入,入,食,食,品,品,后,后,的,的,过,过,敏,敏,反,反,应,应,Symptom,症,症,状,状,：,：,1,）,）Themainsymptomsofgastrointestinalfoodallergyarevomiting,nausea,diarrhea,andabdominalpains(colicsorcramps).,胃,肠,肠,道,道,主,主,要,要,症,症,状,状:,呕,呕,吐,吐,、,、,反,反,胃,胃,、,、,腹,腹,泻,泻,以,以,及,及,腹,腹,部,部,疼,疼,痛,痛,（,（,绞,绞,痛,痛,或,或,痛,痛,性,性,痉,痉,挛,挛,）,）,；,；,2)Skinreactionsincludelocalorgeneralizedpruritus,flush,urticaria,angioedema.morbilliformexanthema,andflare-upofatopicdermatitis,皮肤反,应,应：局,部,部的或,无,无显著,特,特点的,搔,搔痒症,、,、面部,潮,潮红、,风,风疹、,血,血管性,水,水肿、,麻,麻疹样,疹,疹病、,突,突发特,异,异性皮,炎,炎；,3)Thesymptomsofthe upper andthelowerrespiratorytractare rhinitis (sneezing,pruritusofthe nose, nasal stuffiness, andnasalobstruction), larynxedema,cough, wheezing,andbronchial asthma.,上呼吸,道,道或稍,低,低些的,呼,呼吸道,症,症状：,鼻炎（,打,打喷嚏,、,、鼻搔,痒,痒症、,鼻,鼻子不,通,通气、,鼻,鼻塞）,、,、喉肿,、,、咳嗽,、,、喘息,以,以及支,气,气管哮,喘,喘；,4)Itching,redness,andwateringeyes(conjunctivitis),发痒、,充,充血以,及,及眼睛,流,流泪（,结,结膜炎,）,）.,AllergicReactionsAfterInhalationofFood,（,（三）,吸,吸入食,品,品后的,过,过敏反,应,应,Symptom 症,状,状：,respiratorysymptoms,呼,呼吸道,综,综合症,Allergen:,flour,n-amylase,greencoffee, castorandsoy beans,spices. eggwhite,and crustaceans,过敏原,：,：,面粉、,-淀粉,酶,酶、绿,咖,咖啡、,海,海狸香,和,和大豆,、,、调味,品,品、鸡,蛋,蛋白以,及,及甲壳,动,动物,AllergicReactionsFollowing SkinContactWith Food,（四）,皮,皮肤接,触,触食品,后,后的过,敏,敏反应,Allergen:,fish,shrimp, flour,andpork,过敏原,：,：,鱼、小,虾,虾、面,粉,粉和猪,肉,肉,Symptom 症,状,状：,Urticarial lesion,风,风疹,Chronic contactwitha foodmay induceprotein contact, dermatitisinfoodhandlers,食品操,作,作工人,长,长期接,触,触某种,食,食品会,诱,诱导蛋,白,白接触,性,性皮炎,。,。,Non-lgE-Mediated ImmuneReactions,二、不,以,以,IgE,为媒介,的,的免疫,反,反应,HeinersSyndrome,AllergicAlveolitis,and Hemorrhagic GastroenteritisinChildhood,（一）,儿,儿童,Heiner,综合症,、,、过敏,性,性齿槽,炎,炎、出,血,血性肠,胃,胃炎,DEFINITION：,ThetermHeinerssyndromecharacterizes amilk-induced syndrome withpulmonary diseaseininfants.,Heiner,综,综合症,：,：婴儿,因,因牛奶,诱,诱导的,肺,肺病,Symptom 症,状,状：,chronic or recurrentpulmonaryintiltrates,慢,慢性,或,或周期,性,性发生,的,的肺渗,透,透,allergicalveolitis,过,过敏,性,性齿,槽,槽炎,achronicrhinitis,慢,慢,性,性鼻,炎,炎,gastrointestinalbloodlos,iron deficiency anemia 缺铁性贫血,chronic cough 慢性咳嗽,recurrent fever 周期性发烧,Anorexia 厌食,Vomiting 呕吐,Colic 绞痛,Diarrhea 腹泻,Hemoptysis 咳血,Control,控,控,制,制措,施,施：,institutionofamilk-freediet,饮食,中,中去,除,除牛,奶,奶,Gluten-SensitiveEnteropathy(CeliacDisease),（二,）,）谷,蛋,蛋白,敏,敏感,性,性肠,病,病（,乳,乳糜,泻,泻）,Definition,：,：,damagetothesmallintestinalmucosaandsymptomsofmalabsorption,定义,：,：,小肠,黏,黏膜,损,损伤,和,和吸,收,收不,良,良症,状,状小,肠,肠黏,膜,膜损,伤,伤和,吸,吸收,不,不良,症,症状,Allergen,过,过,敏,敏原,：,：,Gliadin,麦,麦,醇,醇溶,蛋,蛋白,presentinwheat,rye,barley,andoat,广泛,存,存在,于,于小,麦,麦、,燕,燕麦,、,、大,麦,麦和,黑,黑麦,中,中,Thepeakincidenceofsymptomsisininfancyaftertheintroductionofcereals;,婴儿,开,开始,添,添加,谷,谷物,类,类食,物,物时,最,最容,易,易发,生,生这,类,类症,状,状，,为,为第,一,一高,峰,峰期,；,；,Asecondpeakoccursduringthethirddecade.,第二,高,高峰,期,期发,生,生在,三,三十,岁,岁。,Symptom,症,症状,：,：,abdominalpain,周,周期,性,性腹,部,部疼,痛,痛,loosestools,便,便溏,anorexia,厌,厌食,shortstature体,态,态短,小,小,delayedpuberty青,春,春期,滞,滞缓,nutritionaldeficiencies,吸,吸收,不,不良,Dentalenamelhypoplasia,牙,牙科,瓷,瓷发,育,育不,全,全,recurrentaphthae周,期,期性,口,口疮,Control,控,控制,措,措施,：,：,Patientswithceliacdiseasemustavoidgliadinsandrelatedproteinspermanently,远离,麦,麦醇,溶,溶蛋,白,白以,及,及相,关,关蛋,白,白质,DermatitisHerpetiformis,（,（,三,三）,疱,疱疹,样,样皮,炎,炎,Definition,定,定,义,义：,chronicblisteringdisease,一种,慢,慢性,起,起疱,疾,疾病,Symptom,症,症状：,itchy,发痒,sometimes burning,有时有灼,伤,伤感,eruptionofgroupedvesiclesonan erythematousground,在红斑状,范,范围内出,现,现成群泡,样,样出疹,SomeDHpatients, even without gastrointestinalsymptoms, may have villous atrophy similar to that seenin celiac disease,有些DH病人,甚,甚至在,没,没有出,现,现胃肠,道,道综合,症,症的情,况,况下，,也,也会出,现,现与乳,糜,糜泻类,似,似的绒,毛,毛状萎,缩,缩症，,也,也就是,说,说DH,与,与CD,之,之间有,关,关连。,The cutaneous manifestations may ormaynot respond toa gluten-free diet,饮食中排除,麦,麦醇溶蛋白,可,可能会、也,有,有可能不会,改,改善皮肤症,状,状。,Eosinophilic Gastroenteritis,（,（四）嗜酸,性,性胃肠炎,Definition,定,定义：,elevated eosinophilcounts inbloodandtissue eosinophiliawithrelease ofeosinophii major basic protein,释放嗜曙红,细,细胞主要基,本,本蛋白质后,，,，血液中嗜,曙,曙红细胞和,嗜,嗜曙红血球,增,增多的间质,组,组织内嗜曙,红,红细胞计数,值,值升高,Clinical manifestations 临,床,床症状：,vomiting,呕吐,abdominalpain,腹部疼痛,Diarrhea,腹泻,malabsorption,吸收不良,bowelobstruction,肠阻塞,Ascites,腹水,The causeof EGis unknown,起因还不清,楚,楚,foodhypersensitivity hasbeensuggested,EG,可能由食品,超,超敏性引起,UtcerativeColitis,（,（五）溃疡,性,性结肠炎,Definition,定,定义：,an inflammatorybowel diseaseof unknownorigin,一种不明起,因,因的炎症性,肠,肠病,No adversefoodreactionshavebeenshown ascausativeof UC,还不能证明,食,食品不良反,应,应会造成,UC,Allergic Vasculitis,（,（六）,变应性脉管,炎,炎,Cause,起,起因：,foodsandfoodadditives,食品及其添,加,加剂,Symptom 症状,：,：,allergic purpura (widespread hemorrhagicmacules and papules, mainly on thelower legs) demonstratedby singlechallenges,变应性紫癜,（,（分布广泛,的,的出血性斑,丘,丘疹，主要,出,出现在腿的,下,下部）,FoodIntolerance,三、,食品不耐性,Lactase Deficiency,乳糖酶缺乏,综,综合征,Definition,定,定义：,Lackof the enzyme that cleavesmilksugar, lactose,givesriseto adverse reactions when lactoseis consumed.,当摄入乳糖,时,时，由于体,内,内缺乏一种,能,能将牛奶糖,质,质,-,乳糖水解的,酶,酶，从而产,生,生不良反应,The only food of which lactoseis anatural constituentis milk (3.7 g/100ml cows milk).,天然含乳糖,的,的唯一食品,是,是牛奶（,3.7g/ml,牛奶）,Classification,分,分类：,1） congenital lactase deficiency,先天性乳糖,酶,酶缺乏综合,征,征,2）,primary lactasedeficiency,初级的乳糖,酶,酶缺乏综合,征,征,3）,secondarylactase deficiency,二级乳糖酶,缺,缺乏综合征,1） congenital lactase deficiency,先,天,天,性,性,乳,乳,糖,糖,酶,酶,缺,缺,乏,乏,综,综,合,合,征,征,lactaseisnotpresentandsymptomswillappearwhenthepatientisbreast-fed.,人,体,体,内,内,不,不,存,存,在,在,乳,乳,糖,糖,酶,酶,，,，,当,当,进,进,行,行,人,人,乳,乳,哺,哺,育,育,时,时,会,会,出,出,现,现,综,综,合,合,征,征,Thecongenitalformisveryrare,这,种,种,症,症,状,状,极,极,少,少,见,见,2,）,）,primarylactasedeficiency,初,级,级,的,的,乳,乳,糖,糖,酶,酶,缺,缺,乏,乏,综,综,合,合,征,征,seeninmostoftheworldspopulationwheretheprodu,在,2-10,岁时，乳糖酶分泌下降或消失,Persistenthighlactaseactivityinadultlifeoccursamongrelativelyfewethnicgroups:,成,年,年,人,人,体,体,内,内,乳,乳,糖,糖,酶,酶,活,活,性,性,一,一,直,直,处,处,于,于,高,高,峰,峰,的,的,人,人,群,群,：,：,northernEuropeansandtheiroverseasdescendants,北,北,欧,欧,以,以,及,及,沿,沿,海,海,后,后,代,代,afewAfricangroupsofpastoraltraditionBedouinsandotherSaudiArabs,一,一,些,些,源,源,于,于,牧,牧,人,人,的,的,非,非,洲,洲,人,人,、,、,贝,贝,都,都,因,因,人,人,和,和,沙,沙,特,特,阿,阿,拉,拉,伯,伯,人,人,certaingroupsfromwestIndiaandPakistan西,印,印度,和,和巴,基,基斯,坦,坦部,分,分人,群,群,3,）,secondarylactasedeficiency,二级,乳,乳糖,酶,酶缺,乏,乏综,合,合征,aconsequenceofpathologicalchangesinthegutmucosa,asseeninceliacdiseaseorinflammations.,乳糜,泻,泻或,炎,炎症,引,引起,内,内脏,黏,黏膜,病,病变,的,的结,果,果,Whenthegutmucosahasrega,当内脏黏膜恢复正常，乳糖酶也开始重新分泌。,Thesymptoms,症,症,状,状：,Diarrhea,腹,腹,泻,泻,gasproduction,产,产,气,气,Colic,绞,绞痛,Control,控,控制,措,措施,：,：,avoidallproductscontainingevensmallamountsoflactose,避免,食,食用,任,任何,含,含乳,糖,糖的,食,食品,PREVALENCE,第,第四,节,节发病,率,率,Thetotalprevalenceoffoodallergy/foodintoleranceisnotknown.,总发,病,病率,未,未知,Estimatesbasedondatafromonecountrydonotnecessarilyreflecttheprevalenceofanothercountry,在某,个,个国,家,家统,计,计得,到,到的,数,数据,并,并不,能,能用,到,到另,一,一个,国,国家,，,，因,为,为：,1）frequencyanddurationofbreastfeeding,母乳,喂,喂养,的,的频,率,率和,持,持续,时,时间,2）eatinghabits饮,食,食习,惯,惯,3）flora,植,植物,群,群,Children,一、,儿,儿童,Food,（一,）,）食,品,品,allergytocowsmilk,egg,andfishpredominantlybeginsbeforethesecondyearofage,对牛,奶,奶、,鸡,鸡蛋,和,和鱼,的,的过,敏,敏性,主,主要,发,发生,2,岁以,前,前,allergytofruit,legumes,andvegetablespredominantlybeginsafterthesecondyear.,对水,果,果、,豆,豆类,和,和蔬,菜,菜的,过,过敏,性,性主,要,要发,生,生在,2,岁以,后,后,Table1PrevalenceofRhinitisandOralItchinDanishSchoolChildren,丹麦,学,学龄,儿,儿童,中,中鼻,炎,炎和,口,口腔,发,发痒,的,的发,病,病率,Age(yr)Rhinitis(%)Oralitch,（%,),boys/girlsboys,/g,irls,5-79.0/5.70/0.38-108.5/7.10.8/1.111-1314.0/8-51.9/1.514-1617.3/13.02.9/2.0,FoodAdditives,（,（二,）,）食,品,品添,加,加剂,Adversereactionstofoodadditivesarefoundin1-2%ofschoolchildren,1-2%学龄,儿,儿童对,食,食品添,加,加剂有,不,不良反,应,应,Theprevalenceinyounger children is notknown.,至今不,知,知小年,龄,龄儿童,的,的发病,率,率,Adults,二,二,、,、成年,人,人,Food,（一）,食,食品,InEuropeanstudies themajorityofallergicfood reactionsinadultsare causedbyfruits. vegetables, andnuts andarerelatedtopollenallergy,在欧洲,，,，大部,分,分成年,人,人食品,过,过敏性,反,反应是,由,由水果,、,、蔬菜,和,和坚果,引,引起的,，,，且与,花,花粉过,敏,敏症有,关,关,Theprevalence is around5%,发病率在,5%,左右,probablyonly 0,5% havesymptomsother thanoralitch.,大约只有,0.5%,不是口腔,发,发痒症状,Theprevalence of allergy tomilk, egg,fish. etc. is around0.2%，牛,奶,奶、鸡蛋,、,、鱼等引,起,起的过敏,症,症发病率,大,大约为,0.2%,FoodAdditives,（,（二）食,品,品添加剂,Theestimated frequencywas0.03-0.15%,1982,年,年EEC,理,理论计算,值,值：食品,添,添加剂引,起,起的发病,率,率为,0.03-0.15%,In British ：theprevalence,大不列颠,人,人,：,发病率为,0.026%,Dutch 丹麦,：0.4%,ContactAllergens （,三,三）接触,性,性过敏原,10 %Danishwomen have contact allergy caused bynickel.,10%丹,麦,麦,妇女因镍,造,造成接触,性,性过敏症,Up to 10% ofthese may benefit froma nickel-restricteddiet,其中,10%,以上会因,排,排除镍的,饮,饮食而改,善,善,Whatiscontactallergens？,In dermallysensitized subjectsingestion ofthecontactallergen may causeskinflare reactionsorother symptoms,e.g., inthegastroinlestinal tract,皮肤敏感,症,症受检者,摄,摄入接触,性,性过敏原,后,后会导致,皮,皮肤潮间,带,带反应或,胃,胃肠道症,状,状等其他,症,症状。,ContactAllergens：,fragrances,芳,芳,香,香,物,物,质,质,foodflavors,（,（naturalorsynthetic,）,）,食,食,品,品,风,风,味,味,物,物,Nickel,镍,镍,OtherAdverseReactions,（,（,四,四,）,）,其,其,它,它,不,不,良,良,反,反,应,应,1,）,）Celiacdisease,腹,腹,部,部,疾,疾,病,病,：,：,Cause,：,：wheatgliadinandrelatedproteins,起,因,因,：,：,小,小,麦,麦,麦,麦,醇,醇,溶,溶,蛋,蛋,白,白,和,和,相,相,关,关,蛋,蛋,白,白,质,质,Theprevalence,：,：0.2-0.5%,发,病,病,率,率,：,：,0.2-0.5%,2,）,）,lactasedeficiency,乳,乳,糖,糖,酶,酶,缺,缺,乏,乏,综,综,合,合,征,征,Cause,：,：,Lackoflactase,起,因,因,：,：,缺,缺,乏,乏,乳,乳,糖,糖,酶,酶,Theprevalence,：,：variesfromafewpercentinnorthernEuropeancountriestoalmosttheentireadultpopulationinAsiaandAfrica,发,病,病,率,率,：,：,从,北,北,欧,欧,国,国,家,家,到,到,亚,亚,洲,洲,和,和,非,非,洲,洲,国,国,家,家,，,，,成,成,年,年,人,人,发,发,病,病,率,率,相,相,差,差,好,好,几,几,个,个,百,百,分,分,点,点,Conclusion,：,：,Itisnotknownwhethertheprevalenceoffoodallergyorintoleranceisincreasing,不,清,清,楚,楚,食,食,品,品,过,过,敏,敏/,不,不,耐,耐,性,性,的,的,发,发,病,病,率,率,是,是,否,否,有,有,上,上,升,升,趋,趋,势,势,Theprevalenceofpollen-relatedfoodallergieshasincreased.,与花粉相关,食,食品敏感症,的,的发病率在,提,提高。,FOODALLERGENS,第五节食品过敏原,Definition,定,定义,Allergensare antigens that give rise toallergy .,过敏原是能,引,引起敏感的,抗,抗原,Whereis food allergens from？,Pollen花粉,Mammals哺乳动,物,物,mites,螨,螨,otherinsects其他,昆,昆虫,foods,食,食品,Component：,过,过敏原成分,：,：,Proteins or glycoproteinswitha molecular weightfrom3 to90 kDa, the majorityranging from 10 to40 kDa,已知结构的,过,过敏原都是,蛋,蛋白质或糖,蛋,蛋白，分子,量,量从3kDa到90kDa，大部,分,分在10kDa到40kDa之间,The identifiedallergens：,the firstthreeletters of thegenus, space,the firstletter ofthe species, space,and an Arabic number.,XXX XX,属 种,阿,阿拉伯数,字,字,For example： Lol p 1refers tothefirstpollen allergen identified from,Lolium perennc, orrye grass,Lolp 1表示,第,第一个花粉,过,过敏原，来,自,自,Lolium perenne,或黑麦草,Classification,分,分类,major,： proteinsforwhich50%or more oftheallergic patients studiedhavespecificIgE,“主要的”,：,：能使,50%,或以上被研,究,究病人具有,特,特异性,IgE,的蛋白质,minor“：,the remaining allergens are considered minor,“次要的”,：,：能使,50%,以下的被研,究,究病人具有,特,特异性,IgE,的蛋白质,The,Nature,of Food Allergens一,、,、过敏原的,种,种类,To make acomplete list of allergenic foods on a globalbasis isvirtuallyimpossible.,我们不可能,列,列出一张食,品,品过敏原清,单,单,Whether afoodallergen causessignificant problems ina population isdependenton several factors：,某种食品过,敏,敏原是否会,在,在消费者中,引,引起明显的,问,问题取决于,以,以下几个方,面,面：,（a）the potencyof the allergen,过,过敏原的,效,效能,someare much more frequent sensitizerslhanothers,有些抗体比,其,其他抗体造,成,成敏感症的,次,次数更多，,e.g., -lactoglobulin inmilkor ovomucoid from egg white,如：牛奶中,的,的-乳球,蛋,蛋白或鸡蛋,蛋,蛋白中的卵,类,类粘蛋白,（b）the physiochemical properties物化,性,性质：,1）Thechemicalstructure,i.e., theamino acid sequence, andthetertiary structure,化学结构如,氨,氨基酸序列,，,，蛋白质三,级,级结构,2）heat stability 热稳定,性,性,3）digestibility,可,可消化性,4）Structural relationshipwithepitopesfromnonfood allergens,非食品过敏,原,原与抗原决,定,定族之间的,结,结构关系,（c） the frequency ofexposure,暴,暴露的频率,：,：,In Europeallergy toriceandbuckwheatis uncommon.,在欧,洲,洲，,稻,稻米,和,和荞,麦,麦一,般,般不,引,引起,敏,敏感,症,症,InJapanriceandbuckwheatarecommonfoodallergens,在日,本,本，,稻,稻米,和,和荞,麦,麦通,常,常是,食,食品,过,过敏,原,原。,(d)therouteofexposure,暴,暴,露,露途,径,径,1）aero-allergens,：,：grasses,pollenoftreesandherbs,，,，housedustmites,，,，ocatdander,飞散,过,过敏,原,原：,草、,树,树或,药,药草,的,的花,粉,粉、,屋,屋尘,螨,螨、,猫,猫毛,发,发皮,屑,屑,2）workenvironment,：,：baker,工作,环,环境,：,：面,包,包工,人,人,3）viatheskin,：,：Naturalrubber(latex),通过,皮,皮肤,：,：天,然,然橡,胶,胶,（,e）cross-reactionstoaero-allergens,飞散,过,过敏,原,原的,交,交叉,反,反应,1) localspeciesofgrass, trees, and herbsandpollution,当地生长,的,的草、树,以,以及药草,种,种类,e.g., Allergy tohazelnuts is commoninareas with manybirch trees,where birchpollenhaylever isfrequent,榛实敏感,症,症一般发,生,生在有许,多,多桦树的,地,地区，在,这,这些地区,经,经常发生,桦,桦树花粉,热,热,2) airpollution空气污,染,染,(f)theageat whichtheallergen isintroduced,受,受过敏原,入,入侵的个,体,体年龄,In earlyinfancyanincreased uptakeofantigentakes placeat atime when the gut-associated lymphoid tissue isstill incompletelydeveloped,在幼年早,期,期，在与,消,消化道相,关,关淋巴组,织,织还没有,发,发育好的,时,时候，抗,原,原的摄入,量,量相对较,高,高。,Allergens ofAnimalOrigin,二,二、来源,于,于动物的,过,过敏原,Milk,（一）牛,奶,奶,1）Albumin, -lactoglobulin,andimmunoglobulinsofmilk are the most importantallergens in infants,婴儿：清,蛋,蛋白、-乳球蛋,白,白和免疫,球,球蛋白,2） In olderchildren, -lactoglobulin, caseins,andI-lactalbumin may bemore reactive.,大孩子：,-乳球,蛋,蛋白、酪,蛋,蛋白和-乳白蛋,白,白,3）inadulthood：casein to bethemost frequent allergen,成人期：,酪,酪蛋白,cross-reactions交,叉,叉反应,Themajorityofpatientswith allergy tocows milkproteinswill also reacttoproteinsfrom sheeps and goatsmilk,大部分对,牛,牛奶蛋白,质,质有敏感,症,症的病人,同,同样对绵,羊,羊奶和山,羊,羊奶有敏,感,感症,Cross-reactionsbetweenmilkfrom thesespeciesis not always present.,各种奶之间,的,的交叉反应,并,并不一直存,在,在,Eggs,（,（二）鸡蛋,the secondmostfrequentfoodallergen in small children after cows milk,在小孩子中,大,大概是仅次,于,于牛奶的食,品,品过敏原,Egg whiteproteins are reported toelicit allergicreactionsmorefrequently than eggyolk.,鸡蛋蛋白比,蛋,蛋黄更易引,起,起过敏反应,蛋黄中的主,要,要过敏原,Protein,蛋白质,Name,分类名,molecular weight,分子量(kDa),Content in egg white,鸡蛋白中的含量(%),Ovomucoid (*key),卵类粘蛋白,Gal d 1,28000,11,Ovalbumin,卵清蛋白,Gal d 2,45000,54,Ovotransferrin or conalbumin,卵铁传递蛋白或伴清蛋白,Gal d 3,78000,12,Lysozyme,溶菌酶,Gal d 4,14000,3.4,cross-reactions,交,交叉反应:,allergy toeggcan be correlated toallergy to bird feathers,鸡蛋敏感症,与,与鸟类羽毛,敏,敏感症之间,有,有相关性,the majorcross-reactingdeterminants are thelivetinsfromegg yolk.,主要交叉反,应,应的决定因,素,素是蛋黄中,的,的卵黄蛋白,Allergensof Plant Origin,三,三、来,源,源于植物的,过,过敏原,The vegetable foodsthatmostcommonly causehypersensitivity symptoms,致敏性蔬菜,种,种类,hazelnut 榛,实,实,Walnut 胡桃,Brazil nut,巴,巴西坚果,Apple,苹,苹果,Almond 杏仁,Peach,桃,桃子,Plum,李,李子,Cherry 樱桃,Peanut 花生,Peas,豌,豌豆,Carrot 胡萝卜,parsley 欧芹,Celery 芹菜,Orange 橘子,Strawberry,草,草莓,Cereals 谷物,The ranking lists vary depending on,各,各种蔬菜,致,致敏程度的,影,影响因素,1）theageof the patients,病人的年龄,2）themethods of diagnosis,诊断方法以,及,及,3）thegeographic locationof the population,地理环境,Fruits,Nuts,andVegetables,（,（一）,水,水果、坚果,和,和蔬菜,Morethan90% of patientswithsensitizationto vegetable foods had concomitantsensitization to pollen 90%,以上,的蔬菜敏感,症,症总是伴随,着,着花粉敏感,症,症而来,In agroupof birchpollen allergies thepatientswithadditionalhypersensitivity tonutsandapples had,：,：,在一组同时,有,有另外的坚,果,果和苹果超,敏,敏性的桦树,花,花粉敏感症,病,病人中,(1) more severesymptomsduring thepollen season,在花粉季节,症,症状严重加,重,重,(2) highervalues ofIgEto birch and hazel pollen,桦树和榛子,花,花粉的IgE值较高,(3) alarger area oftheskinpricktestreactiveto birch and hazel pollencomparedto the group withoutapple andnutallergy,与那些没有,坚,坚果和苹果,超,超敏性病人,相,相比，桦树,和,和榛子花粉,的,的皮肤穿刺,试,试验反应区,域,域要大得多,。,。,The symptoms 主,要,要症状：,Mainly from themouth andpharynx,withitching, swelling ofthelips,tongue, and throat.syndrome.,从嘴到咽发,痒,痒，嘴唇、,舌,舌头以及咽,喉,喉肿胀,Thesesymptomsare calledthe,“,“oralallergy”,“口腔敏感,综,综合症”,cross-reactions交,叉,叉反应:,1）Asensitization tomugwortpollensanddifferent spices, the so-calledmugwort-celery-spices syndrome,hasbeen reported,艾蒿及其,不,不同种艾,属,属植物的,花,花粉有致,敏,敏性，又,称,称艾蒿,-,芹菜,-,香料综合,症,症。,2）It was shownbyprick, RASTstudies,andRAST inhibitionexperiments,皮肤穿刺,、,、RSAT,研究以及,RSAT,抑制实验,证,证明：,a celery-thermolabile allergen seemstobe involvedin celery-birch-pollen-allergicpatients,一种不耐,热,热芹菜过,敏,敏原会导,致,致芹菜,-,桦树,-,花粉敏感,症,症,a thermostable allergenis involvedin celery -mug wort-allergicpatients.,一种耐热,过,过敏原会,导,导致芹菜,-,艾蒿敏感,症,症,Pollen-related foodallergies are thought tobecaused by cross-reactions ofpollen-specificIgEantibodieswithepitopes offood proteins.,花粉特异IgE抗,体,体与食品,蛋,蛋白质的,抗,抗原决定,族,族发生交,叉,叉反应，,导,导致了花,粉,粉相关食,品,品敏感症,Three distinct cross-reactive structuresinpollen and vegetablefoods花,粉,粉和蔬菜,中,中的,3,个明显交,叉,叉反应结,构,构,1） Bet vl is the majorbirch pollenallergen,Betv 1,是主要的,桦,桦树花粉,过,过敏原,Allergens with cross-reactivityto Bet v1 ：,与Betv 1,有交叉反,应,应的过敏,原,原有：,Apples,苹果,Hazelnuts,榛实,cherries,樱桃,Pears,梨子,Celery,艾蒿,carrots,胡萝卜,2）Profilinsarewidely distributed in the plantkingdomandhavebeen identifiedasplant pan Allergens.,Profilin,广,泛,泛,分,分,布,布,在,在,植,植,物,物,王,王,国,国,，,，,被,被,称,称,为,为,“,“,植,植,物,物,pan,过,敏,敏,原,原,”,”,10to20%ofthepollen-allergicpatientsaresensitizedtopronlins.,10-20%,花粉,敏,敏感,病,病人,对,对,profilins,敏感,3）Cross-reactionsofallergen-specificIgEantibodiescanbecausedbyso-calledcross-reactivecarbohydratedeterminantsoffoodandpollenglycoproteins.,食品和花,粉,粉糖蛋白,，,，又称为,“,“交叉,反,反应碳水,化,化合物决,定,定物”会,引,引起,过敏原与,特,特异性IgE抗体,的,的交叉反,应,应,。,Cereals,（,（二）,谷,谷物,twomajor allergens,：,：,两个主要,过,过敏原,IgE：,oneat 47 kDa,oneat 20 kDa,Whenchallengedwithdouble-blind, placebo-controlled food challenge,DBPCFC实验,证,证实,21%of the patientswithsuspected allergy to cereals had symptoms,21%谷,物,物过敏儿,童,童有综合,症,症状,8% had clinicalreactions toonly one cereal,8%儿童,只,只对一种,谷,谷物有临,床,床反应,Themajorityofthechildrenhad clinical reactionstowheat (76%),大部分儿,童,童（76%）对谷,物,物有临床,反,反应,Legumes,（三）豆类,Peanut allergymay be themostcommon food allergyin the UnitedStates,在美国，花,生,生敏感症是,最,最常见的食,品,品敏感症,Allergic reactions are often acuteand severe,过敏反应经,常,常是急性和,严,严重的,The majorpeanut allergen,：,：,主要的花生,过,过敏原：,glycoprotein,糖蛋白,Ara h1， molecular weightof 66 kDa,Ara h2, molecular weightof 17 kDa,The characteristic特征,：,：,heatstable 热,稳,稳定性,a potential source of hiddenfoodallergens,一种“隐藏,性,性食品过敏,原,原”的潜在,资,资源,Natural Rubber(Latex)-RelatedFoodAllergens,（四）与天,然,然橡胶（乳,胶,胶）有关食,品,品过敏原,The latexallergensare proteins from the rubber tree,乳汁过敏原,是,是来自橡胶,树,树的蛋白质,Common antigenic determinantsdemonstrated betweenlatex andavocado,chestnut,and ban