食品敏感性、过敏性反应和食品不耐性

FoodSensitivities,AllergicReactions,andFoodIntolerances

食品敏感性、过敏性反响和食品不耐性CONTENTS主要内容DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION

第一节食品不良反响的定义和机理SYMPTOMSOFADVERSEFOODREACTIONS

第二节食品不良反响的病症DIAGNOSISOFADVERSEFOODREACTIONS

第三节食品不良反响的诊断法PREVALENCE

第四节发病率FOODALLERGENS

第五节食品过敏原FOODADDITIVES

第六节食品添加剂FOODLABELINGINRELATIONTOFOODSENSITIVITIES

第七节与食品过敏性有关的食品标签DEFINITIONANDMECHANISMSOFADVERSEFOODREACTION

第一节食品不良反响的定义和机理

Fig.1ClassificationoffoodsproposedbyEAACI图1EAACI对食品的分级toxicfoodreactions食品毒性反响Aclassicaltoxicfoodreactionisscombroidfishpoisoning,duetolargeamountsofhistamine鲭亚目鱼组胺中毒是典型的食品毒性反响。Foodintolerance食品不耐性

enzymatic(resultingfromanenzymaticdefect,e.g.,lactasedeficiency),“酶促性的〞〔因酶缺陷造成，如乳糖酶缺乏症〕pharmacological(dependingonthedirecteffectof,e.g.,vaso-activeaminesnaturallyfoundinfoods)“药理学的〞〔取决于直接效应，如食品中天然存在的血管活性胺〕“Undefined不明确的〞SYMPTOMSOFADVERSEFOODREACTIONS

第二节食品不良反响的病症IgE-MediatedFoodAllergy

一、以IgE-为媒介的食品敏感症

Characteristic特征ClinicalmanifestationsofIgE-mediatedfoodallergycanremainlocalizedatthesiteoftheprimarydirectcontact,i.e.,一直保持在最初的直接接触部位themouth嘴throat(oralallergysyndrome)咽喉〔口腔敏感综合症〕thegastroiniesrinaltract(isolatedgastrointestinalfoodallergy)胃肠道〔单独的胃肠道食品敏感症〕SkinRespiratorytractGItractCardievascularS.皮肤呼吸道胃肠道心脏血管系统

45%25%20%10%Figure2ClassicalsymptomsofIgE-mediatedfoodailergy图2以IgE为媒介的食品敏感综合症分布OralAllergySyndrome

〔一〕口腔敏感综合病症Allergen:freshfoods(fruitsandvegetables)过敏原：新鲜食品〔如水果和蔬菜〕Symptom病症：Itchingofthelips,mouth,palate，throat嘴唇、嘴、上腭咽喉等处立即发痒Hoarsenessand/orswellingofthelips,tongue,uvula,andlarynx嗓音嘶哑，嘴唇、舌头、小舌、喉等肿胀AllergicReactionsAfterIngestionofFood

〔二〕摄入食品后的过敏反响Symptom病症：1〕Themainsymptomsofgastrointestinalfoodallergyarevomiting,nausea,diarrhea,andabdominalpains(colicsorcramps).胃肠道主要病症:呕吐、反胃、腹泻以及腹部疼痛〔绞痛或痛性痉挛〕；2)Skinreactionsincludelocalorgeneralizedpruritus,flush,urticaria,angioedema.morbilliformexanthema,andflare-upofatopicdermatitis皮肤反响：局部的或无显著特点的搔痒症、面部潮红、风疹、血管性水肿、麻疹样疹病、突发特异性皮炎；3)Thesymptomsoftheupperandthelowerrespiratorytractarerhinitis(sneezing,pruritusofthenose,nasalstuffiness,andnasalobstruction),larynxedema,cough,wheezing,andbronchialasthma.上呼吸道或稍低些的呼吸道病症：鼻炎〔打喷嚏、鼻搔痒症、鼻子不通气、鼻塞〕、喉肿、咳嗽、喘息以及支气管哮喘；4)Itching,redness,andwateringeyes(conjunctivitis)发痒、充血以及眼睛流泪〔结膜炎〕.AllergicReactionsAfterInhalationofFood

〔三〕吸入食品后的过敏反响

Symptom病症：respiratorysymptoms呼吸道综合症Allergen:flour,n-amylase,greencoffee,castorandsoybeans,spices.eggwhite,andcrustaceans过敏原：面粉、α-淀粉酶、绿咖啡、海狸香和大豆、调味品、鸡蛋白以及甲壳动物AllergicReactionsFollowingSkinContactWithFood

〔四〕皮肤接触食品后的过敏反响Allergen:fish,shrimp,flour,andpork过敏原：鱼、小虾、面粉和猪肉

Symptom病症：Urticariallesion风疹Chroniccontactwithafoodmayinduceproteincontact,dermatitisinfoodhandlers食品操作工人长期接触某种食品会诱导蛋白接触性皮炎。

Non-lgE-MediatedImmuneReactions

二、不以IgE为媒介的免疫反响Heiner'sSyndrome,AllergicAlveolitis,andHemorrhagicGastroenteritisinChildhood

〔一〕儿童Heiner综合症、过敏性齿槽炎、出血性肠胃炎DEFINITION：ThetermHeiner'ssyndromecharacterizesamilk-inducedsyndromewithpulmonarydiseaseininfants.Heiner综合症：婴儿因牛奶诱导的肺病

Symptom病症：chronicorrecurrentpulmonaryintiltrates慢性或周期性发生的肺渗透allergicalveolitis过敏性齿槽炎achronicrhinitis慢性鼻炎gastrointestinalbloodloss肠胃失血症irondeficiencyanemia缺铁性贫血chroniccough慢性咳嗽recurrentfever周期性发烧Anorexia厌食Vomiting呕吐Colic绞痛Diarrhea腹泻Hemoptysis咳血Control控制措施：institutionofamilk-freediet饮食中去除牛奶Gluten-SensitiveEnteropathy(CeliacDisease)

〔二〕谷蛋白敏感性肠病〔乳糜泻〕Definition：damagetothesmallintestinalmucosaandsymptomsofmalabsorption定义：小肠黏膜损伤和吸收不良病症小肠黏膜损伤和吸收不良病症Allergen过敏原：Gliadin麦醇溶蛋白presentinwheat,rye,barley,andoat广泛存在于小麦、燕麦、大麦和黑麦中Thepeakincidenceofsymptomsisininfancyaftertheintroductionofcereals;婴儿开始添加谷物类食物时最容易发生这类病症，为第一顶峰期；Asecondpeakoccursduringthethirddecade.第二顶峰期发生在三十岁。Symptom病症：abdominalpain周期性腹部疼痛loosestools便溏anorexia厌食shortstature体态短小delayedpuberty青春期滞缓nutritionaldeficiencies吸收不良Dentalenamelhypoplasia牙科瓷发育不全recurrentaphthae周期性口疮Control控制措施：Patientswithceliacdiseasemustavoidgliadinsandrelatedproteinspermanently远离麦醇溶蛋白以及相关蛋白质DermatitisHerpetiformis〔三〕疱疹样皮炎Definition定义：chronicblisteringdisease一种慢性起疱疾病

Symptom病症：itchy发痒sometimesburning有时有灼伤感eruptionofgroupedvesiclesonanerythematousground在红斑状范围内出现成群泡样出疹SomeDHpatients,evenwithoutgastrointestinalsymptoms,mayhavevillousatrophysimilartothatseeninceliacdisease有些DH病人甚至在没有出现胃肠道综合症的情况下，也会出现与乳糜泻类似的绒毛状萎缩症，也就是说DH与CD之间有关连。Thecutaneousmanifestationsmayormaynotrespondtoagluten-freediet饮食中排除麦醇溶蛋白可能会、也有可能不会改善皮肤病症。EosinophilicGastroenteritis

〔四〕嗜酸性胃肠炎Definition定义：elevatedeosinophilcountsinbloodandtissueeosinophiliawithreleaseofeosinophiimajorbasicprotein释放嗜曙红细胞主要根本蛋白质后，血液中嗜曙红细胞和嗜曙红血球增多的间质组织内嗜曙红细胞计数值升高Clinicalmanifestations临床病症：vomiting呕吐abdominalpain腹部疼痛Diarrhea腹泻malabsorption吸收不良bowelobstruction肠阻塞Ascites腹水ThecauseofEGisunknown起因还不清楚foodhypersensitivityhasbeensuggestedEG可能由食品超敏性引起UtcerativeColitis

〔五〕溃疡性结肠炎Definition定义：aninflammatoryboweldiseaseofunknownorigin一种不明起因的炎症性肠病

NoadversefoodreactionshavebeenshownascausativeofUC还不能证明食品不良反响会造成UCAllergicVasculitis

〔六〕变应性脉管炎Cause起因：foodsandfoodadditives食品及其添加剂Symptom病症：allergicpurpura(widespreadhemorrhagicmaculesandpapules,mainlyonthelowerlegs)demonstratedbysinglechallenges变应性紫癜〔分布广泛的出血性斑丘疹，主要出现在腿的下部〕FoodIntolerance

三、食品不耐性

LactaseDeficiency

乳糖酶缺乏综合征

Definition定义：Lackoftheenzymethatcleavesmilksugar,lactose,givesrisetoadversereactionswhenlactoseisconsumed.当摄入乳糖时，由于体内缺乏一种能将牛奶糖质----乳糖水解的酶，从而产生不良反响Theonlyfoodofwhichlactoseisanaturalconstituentismilk(3.7g/100mlcowsmilk).天然含乳糖的唯一食品是牛奶〔3.7g/ml牛奶〕Classification分类：1〕congenitallactasedeficiency先天性乳糖酶缺乏综合征2〕primarylactasedeficiency初级的乳糖酶缺乏综合征3〕secondarylactasedeficiency二级乳糖酶缺乏综合征1〕congenitallactasedeficiency先天性乳糖酶缺乏综合征lactaseisnotpresentandsymptomswillappearwhenthepatientisbreast-fed.人体内不存在乳糖酶，当进行人乳哺育时会出现综合征Thecongenitalformisveryrare这种病症极少见2〕primarylactasedeficiency初级的乳糖酶缺乏综合征seeninmostoftheworld'spopulationwheretheproductionoflactasedecreasesordisappearsfromtheageof2totheteenageyears在2-10岁时，乳糖酶分泌下降或消失Persistenthighlactaseactivityinadultlifeoccursamongrelativelyfewethnicgroups:成年人体内乳糖酶活性一直处于顶峰的人群：northernEuropeansandtheiroverseasdescendants北欧以及沿海后代afewAfricangroupsofpastoraltraditionBedouinsandotherSaudiArabs一些源于牧人的非洲人、贝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二级乳糖酶缺乏综合征aconsequenceofpathologicalchangesinthegutmucosa,asseeninceliacdiseaseorinflammations.乳糜泻或炎症引起内脏黏膜病变的结果

Whenthegutmucosahasregaineditsnormalappearancethelactaseproductionreappears当内脏黏膜恢复正常，乳糖酶也开始重新分泌。Thesymptoms病症：Diarrhea腹泻gasproduction产气Colic绞痛Control控制措施：avoidallproductscontainingevensmallamountsoflactose防止食用任何含乳糖的食品PREVALENCE

第四节

发病率

Thetotalprevalenceoffoodallergy/foodintoleranceisnotknown.总发病率未知Estimatesbasedondatafromonecountrydonotnecessarilyreflecttheprevalenceofanothercountry在某个国家统计得到的数据并不能用到另一个国家，因为：1〕frequencyanddurationofbreastfeeding母乳喂养的频率和持续时间2〕eatinghabits饮食习惯3〕flora植物群Children

一、儿童

Food

〔一〕食品allergytocow'smilk,egg,andfishpredominantlybeginsbeforethesecondyearofage对牛奶、鸡蛋和鱼的过敏性主要发生2岁以前allergytofruit,legumes,andvegetablespredominantlybeginsafterthesecondyear.对水果、豆类和蔬菜的过敏性主要发生在2岁以后

Table1PrevalenceofRhinitisandOralItchinDanishSchoolChildren丹麦学龄儿童中鼻炎和口腔发痒的发病率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〕食品添加剂Adversereactionstofoodadditivesarefoundin1-2%ofschoolchildren1-2%学龄儿童对食品添加剂有不良反响Theprevalenceinyoungerchildrenisnotknown.至今不知小年龄儿童的发病率Adults

二、成年人

Food

〔一〕食品InEuropeanstudiesthemajorityofallergicfoodreactionsinadultsarecausedbyfruits.vegetables,andnutsandarerelatedtopollenallergy在欧洲，大局部成年人食品过敏性反响是由水果、蔬菜和坚果引起的，且与花粉过敏症有关Theprevalenceisaround5%发病率在5%左右probablyonly0,5%havesymptomsotherthanoralitch.大约只有0.5%不是口腔发痒病症Theprevalenceofallergytomilk,egg,fish.etc.isaround0.2%，，牛奶、鸡蛋、鱼等引起的过敏症发病率大约为0.2%FoodAdditives

〔二〕食品添加剂Theestimatedfrequencywas0.03-0.15%1982年EEC理论计算值：食品添加剂引起的发病率为0.03-0.15%InBritish：theprevalence大不列颠人：发病率为0.026%Dutch丹麦：0.4%ContactAllergens

〔三〕接触性过敏原10%Danishwomenhavecontactallergycausedbynickel.10%丹麦妇女因镍造成接触性过敏症Upto10%ofthesemaybenefitfromanickel-restricteddiet其中10%以上会因排除镍的饮食而改善Whatiscontactallergens？Indermallysensitizedsubjectsingestionofthecontactallergenmaycauseskinflarereactionsorothersymptoms,e.g.,inthegastroinlestinaltract皮肤敏感症受检者摄入接触性过敏原后会导致皮肤潮间带反响或胃肠道病症等其他病症。ContactAllergens：fragrances芳香物质foodflavors〔naturalorsynthetic〕食品风味物Nickel镍

OtherAdverseReactions〔四〕其它不良反响1〕Celiacdisease腹部疾病：Cause：wheatgliadinandrelatedproteins起因：小麦麦醇溶蛋白和相关蛋白质Theprevalence：0.2-0.5%发病率：0.2-0.5%2〕lactasedeficiency乳糖酶缺乏综合征Cause：Lackoflactase起因：缺乏乳糖酶Theprevalence：variesfromafewpercentinnorthernEuropeancountriestoalmosttheentireadultpopulationinAsiaandAfrica发病率：从北欧国家到亚洲和非洲国家，成年人发病率相差好几个百分点Conclusion：Itisnotknownwhethertheprevalenceoffoodallergyorintoleranceisincreasing不清楚食品过敏/不耐性的发病率是否有上升趋势Theprevalenceofpollen-relatedfoodallergieshasincreased.与花粉相关食品敏感症的发病率在提高。FOODALLERGENS

第五节

食品过敏原

Definition定义Allergensareantigensthatgiverisetoallergy.过敏原是能引起敏感的抗原Whereisfoodallergensfrom？Pollen花粉Mammals哺乳动物mites螨otherinsects其他昆虫foods食品Component：过敏原成分：Proteinsorglycoproteinswithamolecularweightfrom3to90kDa,themajorityrangingfrom10to40kDa结构的过敏原都是蛋白质或糖蛋白，分子量从3kDa到90kDa，大局部在10kDa到40kDa之间Theidentifiedallergens：thefirstthreelettersofthegenus,space,thefirstletterofthespecies,space,andanArabicnumber.XXXXX属种阿拉伯数字Forexample：Lolp1referstothefirstpollenallergenidentifiedfromLoliumperennc,orryegrassLolp1表示第一个花粉过敏原，来自Loliumperenne或黑麦草Classification分类"major"：proteinsforwhich50%ormoreoftheallergicpatientsstudiedhavespecificIgE“主要的〞：能使50%或以上被研究病人具有特异性IgE的蛋白质"minor“：theremainingallergensareconsideredminor“次要的〞：能使50%以下的被研究病人具有特异性IgE的蛋白质TheNatureofFoodAllergens

一、过敏原的种类

Tomakeacompletelistofallergenicfoodsonaglobalbasisisvirtuallyimpossible.我们不可能列出一张食品过敏原清单Whetherafoodallergencausessignificantproblemsinapopulationisdependentonseveralfactors：某种食品过敏原是否会在消费者中引起明显的问题取决于以下几个方面：

〔a〕thepotencyoftheallergen

过敏原的效能somearemuchmorefrequentsensitizerslhanothers有些抗体比其他抗体造成敏感症的次数更多，e.g.,β-lactoglobulininmilkorovomucoidfromeggwhite如：牛奶中的β-乳球蛋白或鸡蛋蛋白中的卵类粘蛋白〔b〕thephysiochemicalproperties

物化性质：1〕Thechemicalstructure,i.e.,theaminoacidsequence,andthetertiarystructure化学结构如氨基酸序列，蛋白质三级结构2〕heatstability热稳定性3〕digestibility可消化性4〕Structuralrelationshipwithepitopesfromnonfoodallergens非食品过敏原与抗原决定族之间的结构关系〔c〕thefrequencyofexposure

暴露的频率：InEuropeallergytoriceandbuckwheatisuncommon.在欧洲，稻米和荞麦一般不引起敏感症InJapanriceandbuckwheatarecommonfoodallergens在日本，稻米和荞麦通常是食品过敏原。(d)therouteofexposure

暴露途径1〕aero-allergens：grasses,pollenoftreesandherbs，housedustmites，ocatdander飞散过敏原：草、树或药草的花粉、屋尘螨、猫毛发皮屑2〕workenvironment：baker工作环境：面包工人3〕viatheskin：Naturalrubber(latex)通过皮肤：天然橡胶〔e〕cross-reactionstoaero-allergens

飞散过敏原的交叉反响1)localspeciesofgrass,trees,andherbsandpollution当地生长的草、树以及药草种类e.g.,Allergytohazelnutsiscommoninareaswithmanybirchtrees,wherebirchpollenhayleverisfrequent榛实敏感症一般发生在有许多桦树的地区，在这些地区经常发生桦树花粉热2)airpollution空气污染

(f)theageatwhichtheallergenisintroduced

受过敏原入侵的个体年龄Inearlyinfancyanincreaseduptakeofantigentakesplaceatatimewhenthegut-associatedlymphoidtissueisstillincompletelydeveloped在幼年早期，在与消化道相关淋巴组织还没有发育好的时候，抗原的摄入量相对较高。AllergensofAnimalOrigin

二、来源于动物的过敏原

Milk〔一〕牛奶1〕Albumin,β-lactoglobulin,andimmunoglobulinsofmilkarethemostimportantallergensininfants婴儿：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І-乳白蛋白3〕inadulthood：caseintobethemostfrequentallergen成人期：酪蛋白cross-reactions交叉反响Themajorityofpatientswithallergytocow'smilkproteinswillalsoreacttoproteinsfromsheep'sandgoat'smilk大局部对牛奶蛋白质有敏感症的病人同样对绵羊奶和山羊奶有敏感症Cross-reactionsbetweenmilkfromthesespeciesisnotalwayspresent.各种奶之间的交叉反响并不一直存在Eggs

〔二〕鸡蛋thesecondmostfrequentfoodallergeninsmallchildrenaftercow'smilk在小孩子中大概是仅次于牛奶的食品过敏原

Eggwhiteproteinsarereportedtoelicitallergicreactionsmorefrequentlythaneggyolk.鸡蛋蛋白比蛋黄更易引起过敏反响蛋黄中的主要过敏原Protein蛋白质Name分类名molecularweight分子量(kDa)Contentineggwhite鸡蛋白中的含量(%)Ovomucoid(*key)卵类粘蛋白Gald12800011Ovalbumin卵清蛋白Gald24500054Ovotransferrinorconalbumin卵铁传递蛋白或伴清蛋白Gald37800012Lysozyme溶菌酶Gald4140003.4cross-reactions交叉反响:allergytoeggcanbecorrelatedtoallergytobirdfeathers鸡蛋敏感症与鸟类羽毛敏感症之间有相关性themajorcross-reactingdeterminantsarethelivetinsfromeggyolk.主要交叉反响的决定因素是蛋黄中的卵黄蛋白AllergensofPlantOrigin

三、来源于植物的过敏原

Thevegetablefoodsthatmostcommonlycausehypersensitivitysymptoms

致敏性蔬菜种类hazelnut榛实Walnut胡桃Brazilnut巴西坚果Apple苹果Almond杏仁Peach桃子Plum李子Cherry樱桃Peanut花生Peas豌豆Carrot胡萝卜parsley欧芹Celery芹菜Orange橘子Strawberry草莓Cereals谷物Therankinglistsvarydependingon

各种蔬菜致敏程度的影响因素1〕theageofthepatients病人的年龄2〕themethodsofdiagnosis诊断方法以及3〕thegeographiclocationofthepopulation地理环境Fruits,Nuts,andVegetables

〔一〕水果、坚果和蔬菜Morethan90%ofpatientswithsensitizationtovegetablefoodshadconcomitantsensitizationtopollen90%以上的蔬菜敏感症总是伴随着花粉敏感症而来

Inagroupofbirchpollenallergiesthepatientswithadditionalhypersensitivitytonutsandappleshad：在一组同时有另外的坚果和苹果超敏性的桦树花粉敏感症病人中(1)moreseveresymptomsduringthepollenseason在花粉季节病症严重加重(2)highervaluesofIgEtobirchandhazelpollen,桦树和榛子花粉的IgE值较高(3)alargerareaoftheskinpricktestreactivetobirchandhazelpollencomparedtothegroupwithoutappleandnutallergy与那些没有坚果和苹果超敏性病人相比，桦树和榛子花粉的皮肤穿刺试验反响区域要大得多。Thesymptoms主要病症：Mainlyfromthemouthandpharynx,withitching,swellingofthelips,tongue,andthroat.syndrome.从嘴到咽发痒，嘴唇、舌头以及咽喉肿胀Thesesymptomsarecalledthe“oralallergy〞“口腔敏感综合症〞cross-reactions交叉反响:1〕Asensitizationtomugwortpollensanddifferentspices,theso-calledmugwort-celery-spicessyndrome,hasbeenreported艾蒿及其不同种艾属植物的花粉有致敏性，又称艾蒿-芹菜--香料综合症。2〕Itwasshownbyprick,RASTstudies,andRASTinhibitionexperiments皮肤穿刺、RSAT研究以及RSAT抑制实验证明：acelery-thermolabileallergenseemstobeinvolvedincelery-birch-pollen-allergicpatients一种不耐热芹菜过敏原会导致芹菜-桦树-花粉敏感症athermostableallergenisinvolvedincelery-mugwort-allergicpatients.一种耐热过敏原会导致芹菜-艾蒿敏感症Pollen-relatedfoodallergiesarethoughttobecausedbycross-reactionsofpollen-specificIgEantibodieswithepitopesoffoodproteins.花粉特异IgE抗体与食品蛋白质的抗原决定族发生交叉反响，导致了花粉相关食品敏感症Threedistinctcross-reactivestructuresinpollenandvegetablefoods

花粉和蔬菜中的3个明显交叉反响结构1〕BetvlisthemajorbirchpollenallergenBetv1是主要的桦树花粉过敏原Allergenswithcross-reactivitytoBetv1：与Betv1有交叉反响的过敏原有：Apples苹果Hazelnuts榛实cherries樱桃Pears梨子Celery艾蒿

carrots胡萝卜2〕Profilinsarewidelydistributedintheplantkingdomandhavebeenidentifiedas"plantpanAllergens."Profilin广泛分布在植物王国，被称为“植物pan过敏原〞10to20%ofthepollen-allergicpatientsaresensitizedtopronlins.10-20%花粉敏感病人对profilins敏感3〕Cross-reactionsofallergen-specificIgEantibodiescanbecausedbyso-called"cross-reactivecarbohydratedeterminants"offoodandpollenglycoproteins.食品和花粉糖蛋白，又称为“交叉反响碳水化合物决定物〞会引起过敏原与特异性IgE抗体的交叉反响。Cereals

〔二〕谷物twomajorallergens：两个主要过敏原IgE：oneat47kDaoneat20kDaWhenchallengedwithdouble-blind,placebo-controlledfoodchallengeDBPCFC实验证实21%ofthepatientswithsuspectedallergytocerealshadsymptoms21%谷物过敏儿童有综合病症8%hadclinicalreactionstoonlyonecereal8%儿童只对一种谷物有临床反响Themajorityofthechildrenhadclinicalreactionstowheat(76%)大局部儿童〔76%〕对谷物有临床反响Legumes〔三〕豆类PeanutallergymaybethemostcommonfoodallergyintheUnitedStates在美国，花生敏感症是最常见的食品敏感症Allergicreactionsareoftenacuteandsevere过敏反响经常是急性和严重的Themajorpeanutallergen：主要的花生过敏原：

glycoprotein糖蛋白Arah1，molecularweightof66kDaArah2,molecularweightof17kDa{Thecharacteristic特征：heatstable热稳定性apotentialsourceof"hiddenfoodallergens一种“隐藏性食品过敏原〞的潜在资源NaturalRubber(Latex)-RelatedFoodAllergens

〔四〕与天然橡胶〔乳胶〕有关食品过敏原

Thelatexallergensareproteinsfromtherubbertree乳汁过敏原是来自橡胶树的蛋白质

Commonantigenicdeterminantsdemonstratedbetweenlatexandavocado,chestnut,andbanana乳汁与鳄梨、栗子和香蕉之间存在共同的抗原定子Allergytonaturalrubber(latex)hasbecomeincreasinglyproblematic天然橡胶〔乳汁〕敏感症有上升趋势Thesereactionsaresevere,e.g.,anaphylacticshock许多反响是严重的，如过敏性休克FOODADDITIVES

第六节

食品添加剂

Chemicallyandfunctionallyfoodadditivesareaveryheterogeneousgroupofsubstancesconsistingof：化学性的和功能性的食品添加剂的组成：

Enzymes酶Flavors风味物Colors色素Preservatives防腐剂

Emulsifiers乳化剂Antioxidants抗氧化剂Sweeteners甜味剂

Colors

一、色素

AzoColors

〔一〕含氮色素Theazocolorscauseadversereactions:会造成不良反响的含氮色素：tartrazine酒石黄sunsetyellow落日黄azorubin/carmoisin偶氮玉红amaranth苋菜红ponceau4R丽春红4RSymptoms:mainlyontheskinandmainlyurticaria主要病症：皮肤风疹Tartrazinehasbeentheadditiveofchoicewhenresearchershavetriedtoelucidatethemechanismoffood-additiveintolerance酒石黄作为机理实验物apharmacologicaleffectoftartrazineandotherazocolors酒石黄和其他含氮色素具有药物学影响pharmacologicaleffect：药物学影响：alargecumulativedoseoftartrarine(200mg)innormalsubjectsresultedinasignificantriseinplasmaandurinaryhistaminelevels.患者体内酒石黄积累到很高浓度时，血浆和尿液中组胺浓度明显升高Thehistaminereleasewasnotaccompaniedbysystemicsymptoms全身组织综合病症导致组胺不能完全释放出来Nonazocolors

〔二〕无氮色素Nonazocolorscouldgiveadversereactions:会造成不良反响的无氮色素：Annatto果红Indigo靛蓝Carmine胭脂红Erythrosine赤藓红patentblue专利蓝(三苯甲烷系染料〕Symptoms:mainlyontheskinandmainlyurticaria主要病症为皮肤风疹Preservatives

二、防腐剂

BenzoicandSorbicAcid

〔一〕安息香酸和山梨酸causesofurticaria造成接触性风疹provokeitchingandtinglinginthemouth出现口腔发痒和麻刺感Themechanismisnotknown其致病机制未知Sulfites

〔二〕亚硫酸盐symptoms病症：asthma哮喘anaphylacticreactions皮肤过敏symptomsontheskin皮肤综合症thelikelihoodofareactiondependon：

致敏反响的可能性取决于：Thenatureofthefood食品的特性thelevelofresidualsulfite亚硫酸盐的残留水平thesensitivityofthepatient病人的敏感性theformofresidualsulfite亚硫酸盐的残留形式themechanismofthesulfite-inducedreaction亚硫酸盐诱导反响机理thecauseofasthmaticreactionstosulfltesinfood

亚硫酸盐哮喘反响的原因：inhalationofsulfurdioxideliberatedduringingestion食用时吸入了二氧化硫deficiencyofsulfiteoxidase缺乏亚硫酸盐氧化酶Metabisulfite偏亚硫酸氢钠Metabisulfite-inducedbasophilhistaminereleaseinanonasthmaticpatient偏亚硫酸氢盐具有诱发嗜碱细胞释放组胺的功能developedurticariaandangioedemafollowingprovocationwithsodiummetabisulfite偏亚硫酸氢钠激发会造成风疹和血管性水肿anIgE-mediatedreaction偏亚硫酸氢钠的敏感性是一种以IgE为媒介的反响FlavorEnhancersandFlavors

三、风味促进剂和香精

FlavorEnhancers:MonosodiumGlutamate

〔一〕风味促进剂：味精Theresultofmonosodiumglutamate(MSG)wastheChineserestaurantsyndrome(CRS)andasthma。味精会造成：中国餐馆综合症〔CRS〕喘病症1〕symptomsofCRS病症：headache头痛aburningsensationalongthebackoftheneck沿着脖子背部的灼热感chesttightness胸闷Nausea作呕Sweating发汗SymptomscharacteristicoftheChineserestaurantsyndromecanbeprovokedinalimitednumberofindividuals