CureMD delivers knowledge when and where required through integrated applications and evidence based knowledge base, and alerting system. Rich functionalities spanning over forty modules and sub-systems directly connect with remote offices, pharmacies, labs and devices to deliver instant and complete access to all the information you need, when you need it.
CureMD supports continuity of care management through innovative tools that adapt to your unique workflow and clinical approach. Specialty specific, template driven, point and click technology accurately documents patient encounters and transactions.
CureMD simplifies decision making, streamlines operations and ensures compliance to industry standards and best practices, ultimately saving time and effort to maximize value and returns.
Features
* Problems & Complaints
* History (Present Illness, Family, Social, Medical)
* Vitals
* Review of Systems
* Physical Exam (Inspection, Palpation, Auscultation)
* Electronic Prescriptions (CPOE)
* Lab Interfaces
* Document Imaging
* Clinical Knowledge Base
* Decision Support
* Disease Management
* Workflow Editor
* Auto Note
* Referral Management
* Follow-up/Recall Tracking
* Patient Education
* Electronic Signature
* eFax Capability
* Voice Recognition
* Trending & Graphing
* Integrated PQRI
* Denial Management
* Treatment Plans/Order Sets
* Continuity of Care Document (CCD)
* Immunization Information System
* KPI Dashboard
* Biometric Authentication
* Integrated Clinical Reference Material
* Business Process Designer
Integrated Modules
* Patient Profile
* Enterprise Scheduling
* Eligibility Verification
* Electronic Billing
* Workflow Management
* E&M Coding Optimization
* Enterprise Messaging
* Calendar, Email & Reminders
* Notes & Task Management
* Audit Trail & Access Control
* Cure Patient Portal
* Data Mining Reports
Specialty Knowledge Base: (Click to find your Specialty Information)
Allergy
Allergy
Ambulatory Surgery Center Ambulatory Surgery Center
Cardiology
Cardiology
Dermatology Dermatology
Emergency Medicine
Emergency Medicine
Endocrinology
Endocrinology
General Surgery
General Surgery
Gastroenterology
Gastroenterology
Hand Surgery
Hand Surgery
Home Care
Home Care
Internal Medicine
Internal Medicine
Infectious Disease
Infectious Disease
Obstetrics /Gynecology
Obstetrics /Gynecology
Neurology
Neurology
Orthopedics
Orthopedics
Oncology
Oncology
Otolaryngology
Otolaryngology
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Ophthalmology
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Pediatrics
Pain Management
Pain Management
Podiatry
Podiatry
Physical Medicine
Physical Medicine
Pulmonary
Pulmonary
Primary Care, Family Practice
Primary Care, Family Practice
Rheumatology
Rheumatology
Rehabilitative Medicine
Rehabilitative Medicine
Nursing Nursing Speech Therapy Speech Therapy
Sleep Sleep Vascular Surgery Vascular Surgery
Urology Urology Student and Employee Health Care Services Student and Employee Health Care Services
All-in-One Solution
Click for preview
Electronic Medical Records (EMR)
CureMD Electronic Medical records is a browser based, customizable CCHIT certified solution designed to empower care providers of the internet age. CureMD EMR supports continuity of care management through innovative tools that adapt to your unique workflow and clinical approach.
(Learn More)
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Practice Management System
CureMD PMS is a web based enterprise practice management solution designed to meet the broadest possible range of a modern practice's administrative, communication and fiscal management needs.
(Learn More)
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Mobile Care Management
CureMobile† extends the functionality of CureMD by providing a complete, fully integrated point-of-care solution.
(Learn More)
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Patient Portal
Facilitate your patients to securely request appointment and refills online, receive test results as they become available, utilize educational material and update their health status, history, demographics and insurance information while subscribing to valuable electronic services.
(Learn More)
Click for preview
Computerized Physician Order Entry
Electronic orders and results management for prescriptions, labs, procedures and radiology allow you to work more efficiently and make swift, well informed and confident decisions.
(Learn More)
Monday, August 3, 2009
Allergy (Immunology) EMR
CureMD Allergy & Immunology EMR is a configurable solution transforming the way Immunologists capture, manage and exchange patient clinical and financial information. The system offers built-in SOAP templates attuned to Allergy & Immunology. These readymade point & click templates cover most common Immunology treatments and allow complete customization to match your personalized practice needs.
In addition to standard EMR features, following Immunology specific functionalities are built in:
* Treatment protocols for Defense mechanisms & Inflammation
* Consolidation of vaccination data
* Generation of reminders and recall notifications
* Assessments of vaccination coverage
* Adverse event reporting
* Tracking of Immunodeficiencies & Immunomodulation
* Lifetime vaccination histories
* Tracking of Organ specific inflammatory diseases
The system enables Immunologists enhance their practice throughput by streamlining the entire set of operational procedures right from patient scheduling to treatment planning and beyond. Moreover, the system is embedded with all current ICD and CPT codes, allowing Immunologists capture, submit and track charges electronically. The latest version of the application also supports advanced features like KPI based digital dashboards, RightRemit, Auto Note and built in clinical decision support.
All-in-One Solution
Click for preview
Electronic Medical Records (EMR)
CureMD Electronic Medical records is a browser based, customizable CCHIT certified solution designed to empower care providers of the internet age. CureMD EMR supports continuity of care management through innovative tools that adapt to your unique workflow and clinical approach.
(Learn More)
Click for preview
Practice Management System
CureMD PMS is a web based enterprise practice management solution designed to meet the broadest possible range of a modern practice's administrative, communication and fiscal management needs.
(Learn More)
Click for preview
Mobile Care Management
CureMobile† extends the functionality of CureMD by providing a complete, fully integrated point-of-care solution.
(Learn More)
Click for preview
Patient Portal
Facilitate your patients to securely request appointment and refills online, receive test results as they become available, utilize educational material and update their health status, history, demographics and insurance information while subscribing to valuable electronic services.
(Learn More)
Click for preview
Computerized Physician Order Entry
Electronic orders and results management for prescriptions, labs, procedures and radiology allow you to work more efficiently and make swift, well informed and confident decisions.
In addition to standard EMR features, following Immunology specific functionalities are built in:
* Treatment protocols for Defense mechanisms & Inflammation
* Consolidation of vaccination data
* Generation of reminders and recall notifications
* Assessments of vaccination coverage
* Adverse event reporting
* Tracking of Immunodeficiencies & Immunomodulation
* Lifetime vaccination histories
* Tracking of Organ specific inflammatory diseases
The system enables Immunologists enhance their practice throughput by streamlining the entire set of operational procedures right from patient scheduling to treatment planning and beyond. Moreover, the system is embedded with all current ICD and CPT codes, allowing Immunologists capture, submit and track charges electronically. The latest version of the application also supports advanced features like KPI based digital dashboards, RightRemit, Auto Note and built in clinical decision support.
All-in-One Solution
Click for preview
Electronic Medical Records (EMR)
CureMD Electronic Medical records is a browser based, customizable CCHIT certified solution designed to empower care providers of the internet age. CureMD EMR supports continuity of care management through innovative tools that adapt to your unique workflow and clinical approach.
(Learn More)
Click for preview
Practice Management System
CureMD PMS is a web based enterprise practice management solution designed to meet the broadest possible range of a modern practice's administrative, communication and fiscal management needs.
(Learn More)
Click for preview
Mobile Care Management
CureMobile† extends the functionality of CureMD by providing a complete, fully integrated point-of-care solution.
(Learn More)
Click for preview
Patient Portal
Facilitate your patients to securely request appointment and refills online, receive test results as they become available, utilize educational material and update their health status, history, demographics and insurance information while subscribing to valuable electronic services.
(Learn More)
Click for preview
Computerized Physician Order Entry
Electronic orders and results management for prescriptions, labs, procedures and radiology allow you to work more efficiently and make swift, well informed and confident decisions.
Sunday, August 2, 2009
Allergies
About Allergies
Dr.Shahid Abbas believes that there is lack of awareness in general public about allergies which are neither easily understood nor easily treated. Patient needs a great deal of information so that they can treat themselves. They should note early warning signs of allergies in children and adults and prevent serious and life threatening allergic conditions. Parents and teachers should note the early signs and symptoms in their children .
Types of Allergy
Hormone allergy is a type of allergic reaction experienced by women from before puberty to old age. It is a heightened or extra ordinary reaction to the normal function of hormones.And while there are many journal references to the connection between hormones and symptoms, I am aware of only one recent textbook that actually suggests a hormone allergy.
Mold Allergies
Most people will realize what they are reacting to because there are clearly defined SEASONS when the most common and the most powerful pollens occur. Fall, for example, is CANNABIS OR PIG WEED season. So, if you get a stuffy nose and a low-grade fever (up to 100 degrees) during August or September, you are probably having an allergy attack.
Food Allergies
If you are allergic to a food, you tend to LOVE IT or HATE IT; as such foods usually are addictive. As a result, most people will pick the foods to which they are MOST ALLERGIC. Most of my patients will find that they react to one or more of these foods when they re-introduce them following five days of avoidance. This is called UNMASKING the FOOD ALLERGY.
Do you know Allergy can Cause ( Symptoms )
ALLERGY CANNOT DO EVERY THING BUT CAN DO ANYTHING. Let me explain this in very simple words that allergy can effect every system in the body and can casue any of the following symptoms.
If all other medical causes of the following symptoms have been eliminated, the symptoms may be caused by allergy. This is especially true of symptoms that occur seasonally or that come and go.
ontact Information ( outstation Visits & Vaccine orders)
When you call, please let us know that you will be coming from out of town so we may help with accommodations. We suggest that you plan to travel to Islamabad the evening before and schedule your appointment early so there will be plenty of time to see you as a New Patient. Our office at Khyber Plaza, located on Fazal e Haque road, Blue Artea, behind Citi Bank.n Building.
Allergens
Allergy is an adverse immune reaction to a protein or allergen in our
environment that is normally harmless to the non-allergic individual.
It can manifest itself as itching of the skin, tissue swelling and
wheezing or even progress to full-blown anaphylaxis and death
A process of sensitisation must first take place
Hormone Allergy
Hormone allergy is a type of allergic reaction experienced by women from before puberty to old age. It is a heightened or extra ordinary reaction to the normal function of hormones.And while there are many journal references to the connection between hormones and symptoms, I am aware of only one recent textbook that actually suggests a hormone allergy.
Dr.Shahid Abbas believes that there is lack of awareness in general public about allergies which are neither easily understood nor easily treated. Patient needs a great deal of information so that they can treat themselves. They should note early warning signs of allergies in children and adults and prevent serious and life threatening allergic conditions. Parents and teachers should note the early signs and symptoms in their children .
Types of Allergy
Hormone allergy is a type of allergic reaction experienced by women from before puberty to old age. It is a heightened or extra ordinary reaction to the normal function of hormones.And while there are many journal references to the connection between hormones and symptoms, I am aware of only one recent textbook that actually suggests a hormone allergy.
Mold Allergies
Most people will realize what they are reacting to because there are clearly defined SEASONS when the most common and the most powerful pollens occur. Fall, for example, is CANNABIS OR PIG WEED season. So, if you get a stuffy nose and a low-grade fever (up to 100 degrees) during August or September, you are probably having an allergy attack.
Food Allergies
If you are allergic to a food, you tend to LOVE IT or HATE IT; as such foods usually are addictive. As a result, most people will pick the foods to which they are MOST ALLERGIC. Most of my patients will find that they react to one or more of these foods when they re-introduce them following five days of avoidance. This is called UNMASKING the FOOD ALLERGY.
Do you know Allergy can Cause ( Symptoms )
ALLERGY CANNOT DO EVERY THING BUT CAN DO ANYTHING. Let me explain this in very simple words that allergy can effect every system in the body and can casue any of the following symptoms.
If all other medical causes of the following symptoms have been eliminated, the symptoms may be caused by allergy. This is especially true of symptoms that occur seasonally or that come and go.
ontact Information ( outstation Visits & Vaccine orders)
When you call, please let us know that you will be coming from out of town so we may help with accommodations. We suggest that you plan to travel to Islamabad the evening before and schedule your appointment early so there will be plenty of time to see you as a New Patient. Our office at Khyber Plaza, located on Fazal e Haque road, Blue Artea, behind Citi Bank.n Building.
Allergens
Allergy is an adverse immune reaction to a protein or allergen in our
environment that is normally harmless to the non-allergic individual.
It can manifest itself as itching of the skin, tissue swelling and
wheezing or even progress to full-blown anaphylaxis and death
A process of sensitisation must first take place
Hormone Allergy
Hormone allergy is a type of allergic reaction experienced by women from before puberty to old age. It is a heightened or extra ordinary reaction to the normal function of hormones.And while there are many journal references to the connection between hormones and symptoms, I am aware of only one recent textbook that actually suggests a hormone allergy.
Food
Food is any substance normally eaten or drunk by living organisms. The term food also includes liquid drinks. Food is the main source of energy and of nutrition for animals, and is usually of animal or plant origin.
There are various names for fake food including: pretend food, wax food, artificial food, faux food, replica food, imitation food, food replicas, false foods, food fakes and simulated food.
History
Fake food dishes in a restaurant in Japan.
Fake food dates back to the time of the Pharaohs of Egypt and perhaps before. When a King or Pharaoh died, they were often buried with everything they needed for their journey to the next world. Foods were preserved and laid to rest with them in their tomb.
Modern times saw increased use of fake food. During the early Shōwa period, following Japan’s surrender ending World War II, Americans and Europeans traveled to Japan to help with the rebuilding efforts. Foreign travelers had difficulties reading Japanese menus, so Japanese artisans and candle makers quickly developed plates of wax foods for restaurants that made it easy for foreigners order something that looked good.[1] Paraffin was used to create fake food until the mid-1980s; because its colors faded when exposed to heat or sunlight, manufacturers later switched to vinyl chloride, which is "nearly eternal".[2]
[edit] Modern Use
Fake foods are used in many ways, such as props for backgrounds in movies, television shows, theatrical plays, television commercials, print ads and trade shows. Fake foods are also used to display lifelike replicas of real foods for restaurants, grocery chains, museums, banquet halls, casino buffets, cruise ships and in many other instances in which real foods can not be displayed. For instance, the American company Fake Foods began when fast food restaurant Wendy's needed fake kale for their salad bar display.[3]
Many of Japan’s restaurants still use fake foods to display their popular dishes in their windows and attract customers. The plastic replicas are much more expensive than the food they imitate, but can last indefinitely. For this reason, many companies that manufacture fake food have stagnant or declining profits.[4]
[edit] Manufacturing Process
Today’s manufacturing technologies and high quality plastic materials provide realistic-looking fake food replicas, and approximately 95% of all fake food is still handcrafted. Artisans and highly trained craftsmen make realistic fake food, often painting them by hand to create a realistic look and feel. Some Japanese fake food manufacturers mimic the actual cooking process, employing chef's knives to chop plastic vegetables and real hot oil to fry plastic shrimp.[5]
At the beginning of the production process, real food is dipped in silicone to create a mold. A liquid plastic of the correct color, typically vinyl chloride, is poured into the mold, then heated in an oven until it solidifies.[1] When a food is not available or it would disintegrate or melt in the mold while the mold is setting up, a clay model of the food must be sculpted first. After setting for ten to thirty minutes, any excess vinyl buildup is trimmed off. Next, the replica is painted either by hand or airbrush. If the food has many parts, such as a hamburger or sushi roll, the item is assembled from many vinyl pieces.
There are various names for fake food including: pretend food, wax food, artificial food, faux food, replica food, imitation food, food replicas, false foods, food fakes and simulated food.
History
Fake food dishes in a restaurant in Japan.
Fake food dates back to the time of the Pharaohs of Egypt and perhaps before. When a King or Pharaoh died, they were often buried with everything they needed for their journey to the next world. Foods were preserved and laid to rest with them in their tomb.
Modern times saw increased use of fake food. During the early Shōwa period, following Japan’s surrender ending World War II, Americans and Europeans traveled to Japan to help with the rebuilding efforts. Foreign travelers had difficulties reading Japanese menus, so Japanese artisans and candle makers quickly developed plates of wax foods for restaurants that made it easy for foreigners order something that looked good.[1] Paraffin was used to create fake food until the mid-1980s; because its colors faded when exposed to heat or sunlight, manufacturers later switched to vinyl chloride, which is "nearly eternal".[2]
[edit] Modern Use
Fake foods are used in many ways, such as props for backgrounds in movies, television shows, theatrical plays, television commercials, print ads and trade shows. Fake foods are also used to display lifelike replicas of real foods for restaurants, grocery chains, museums, banquet halls, casino buffets, cruise ships and in many other instances in which real foods can not be displayed. For instance, the American company Fake Foods began when fast food restaurant Wendy's needed fake kale for their salad bar display.[3]
Many of Japan’s restaurants still use fake foods to display their popular dishes in their windows and attract customers. The plastic replicas are much more expensive than the food they imitate, but can last indefinitely. For this reason, many companies that manufacture fake food have stagnant or declining profits.[4]
[edit] Manufacturing Process
Today’s manufacturing technologies and high quality plastic materials provide realistic-looking fake food replicas, and approximately 95% of all fake food is still handcrafted. Artisans and highly trained craftsmen make realistic fake food, often painting them by hand to create a realistic look and feel. Some Japanese fake food manufacturers mimic the actual cooking process, employing chef's knives to chop plastic vegetables and real hot oil to fry plastic shrimp.[5]
At the beginning of the production process, real food is dipped in silicone to create a mold. A liquid plastic of the correct color, typically vinyl chloride, is poured into the mold, then heated in an oven until it solidifies.[1] When a food is not available or it would disintegrate or melt in the mold while the mold is setting up, a clay model of the food must be sculpted first. After setting for ten to thirty minutes, any excess vinyl buildup is trimmed off. Next, the replica is painted either by hand or airbrush. If the food has many parts, such as a hamburger or sushi roll, the item is assembled from many vinyl pieces.
Food science
Food science is a study concerned with all technical aspects of food, beginning with harvesting or slaughtering, and ending with its cooking and consumption. It is considered one of the agricultural sciences, and is usually considered distinct from the field of nutrition.
Examples
Examples of the activities of food scientists include the development of new food products, design of processes to produce these foods, choice of packaging materials, shelf-life studies, sensory evaluation of the product with trained expert panels or potential consumers, as well as microbiological and chemical testing. Food scientists at universities may study more fundamental phenomena that are directly linked to the production of particular food product and its properties. In the U.S., food science is typically studied at land-grant universities.
Food science is a highly interdisciplinary applied science. It incorporates concepts from many different fields including microbiology, chemical engineering, biochemistry, and many others.
Some of the subdisciplines of food science include:
* Food safety - the causes, prevention and communication dealing with foodborne illness
* Food microbiology - the positive and negative interactions between micro-organisms and foods
* Food preservation - the causes and prevention of quality degradation
* Food engineering - the industrial processes used to manufacture food
* Product development - the invention of new food products
* Sensory analysis - the study of how food is perceived by the consumer's senses
* Food chemistry - the molecular composition of food and the involvement of these molecules in chemical reactions
* Food packaging - the study of how packaging is used to preserve food after it has been processed and contain it through distribution.
* Molecular gastronomy - the scientific investigation of processes in cooking, social & artistic gastronomical phenomena
* Food technology - the technological aspects
* Food physics - the physical aspects of foods (such as viscosity, creaminess, and texture)
The main organization in the United States regarding food science and food technology is the Institute of Food Technologists (IFT), headquartered in Chicago, Illinois, which is the US member organisation of the International Union of Food Science and Technology (IUFoST). The European national organisations are organised into the European Federation of Food Science and Technology (EFFoST), based at Wageningen University, the Netherlands.
Some popular books on some aspects of food science or kitchen science have been written by Harold McGee and Howard Hillman.
In the October 2006 issue of Food Technology, 2006-07 IFT President Dennis R. Heldman noted that the IFT Committee on Higher Education gave the current definition of food science as follows: "Food Science is the discipline in which the engineering, biological, and physical sciences are used to study the nature of foods, the causes of deterioration, the principles underlying food processing, and the improvement of foods for the consuming public."[1]
[edit] References
Food science is a study concerned with all technical aspects of food, beginning with harvesting or slaughtering, and ending with its cooking and consumption. It is considered one of the agricultural sciences, and is usually considered distinct from the field of nutrition.
Examples
Examples of the activities of food scientists include the development of new food products, design of processes to produce these foods, choice of packaging materials, shelf-life studies, sensory evaluation of the product with trained expert panels or potential consumers, as well as microbiological and chemical testing. Food scientists at universities may study more fundamental phenomena that are directly linked to the production of particular food product and its properties. In the U.S., food science is typically studied at land-grant universities.
Food science is a highly interdisciplinary applied science. It incorporates concepts from many different fields including microbiology, chemical engineering, biochemistry, and many others.
Some of the subdisciplines of food science include:
* Food safety - the causes, prevention and communication dealing with foodborne illness
* Food microbiology - the positive and negative interactions between micro-organisms and foods
* Food preservation - the causes and prevention of quality degradation
* Food engineering - the industrial processes used to manufacture food
* Product development - the invention of new food products
* Sensory analysis - the study of how food is perceived by the consumer's senses
* Food chemistry - the molecular composition of food and the involvement of these molecules in chemical reactions
* Food packaging - the study of how packaging is used to preserve food after it has been processed and contain it through distribution.
* Molecular gastronomy - the scientific investigation of processes in cooking, social & artistic gastronomical phenomena
* Food technology - the technological aspects
* Food physics - the physical aspects of foods (such as viscosity, creaminess, and texture)
The main organization in the United States regarding food science and food technology is the Institute of Food Technologists (IFT), headquartered in Chicago, Illinois, which is the US member organisation of the International Union of Food Science and Technology (IUFoST). The European national organisations are organised into the European Federation of Food Science and Technology (EFFoST), based at Wageningen University, the Netherlands.
Some popular books on some aspects of food science or kitchen science have been written by Harold McGee and Howard Hillman.
In the October 2006 issue of Food Technology, 2006-07 IFT President Dennis R. Heldman noted that the IFT Committee on Higher Education gave the current definition of food science as follows: "Food Science is the discipline in which the engineering, biological, and physical sciences are used to study the nature of foods, the causes of deterioration, the principles underlying food processing, and the improvement of foods for the consuming public."[1]
[edit] References
Allergy
Statistics
For reasons that are not entirely understood, the diagnosis of food allergies has apparently become more common in Western nations in recent times.[4] In the United States food allergy affects as many as 5% of infants less than three years of age[26] and 3% to 4% of adults.[27] There is a similar prevalence in Canada.[28]
The most common food allergens include peanuts, milk, eggs, tree nuts, fish, shellfish, soy, and wheat - these foods account for about 90% of all allergic reactions.[citation needed]
[edit] Differing views
Various medical practitioners have a differing views on food allergies. Irritable Bowel Syndrome (IBS) patients have been studied with regards to food allergies. Some studies have reported on the role of food allergy in IBS; only one epidemiological study on functional dyspepsia and food allergy has been published. However, since 2005 several studies have demonstrated strong correlation between IgG and/or IgE food allergy and IBS symptoms[29][30][31] The mechanisms by which food activates mucosal immune system are incompletely understood, but food specific IgE and IgG4 appeared to mediate the hypersensitivity reaction in a subgroup of IBS patients. Specific chemicals and receptors have been demonstrated to be critical in food allergy development in murine models.[32] Exclusion diets based on skin prick test, RAST for IgE or IgG4, hypoallergic diet and clinical trials with oral disodium cromoglycate have been conducted, and some success has been reported in a subset of IBS patients.[33]
Studies comparing skin prick testing and ELISA blood testing have found that the results of skin prick testing correlate poorly with symptoms of irritable bowel syndrome that correlate with food allergies demonstrated through ELISA testing and dietary challenge.[34]
Extensive clinical experience has demonstrated significant improvement of patients with IBS whose ELISA-based food allergy testing is positive and where treatment includes a careful exclusion diet.[35]
In addition, many practitioners of alternative medicine ascribe symptoms to food allergy where other doctors do not. The causal relationships between some of these conditions and food allergies have not been studied extensively enough to provide sufficient evidence to become authoritative. The interaction of histamine with the nervous system receptors has been demonstrated, but more study is needed.[36] Other immune response effects are commonly known (swelling, irritation, etc.), but their relationships to some conditions has not been extensively studied. Examples are arthritis, fatigue, headaches, and hyperactivity. Nevertheless, hypoallergenic diets reportedly can be of benefit in these conditions, indicating that the current medical views on food allergy may be too narrow.
[edit] In children
Milk and soy allergies in children can often go undiagnosed for many months, causing much worry for parents and health risks for infants and children. Many infants with milk and soy allergies can show signs of colic, blood in the stool, mucous in the stool, reflux, rashes and other harmful medical conditions.[citation needed] These conditions are often misdiagnosed as viruses or colic.
Some children who are allergic to cow's milk protein also show a cross sensitivity to soy-based products.[37] There are infant formulas in which the milk and soy proteins are degraded so when taken by an infant, their immune system does not recognize the allergen and they can safely consume the product. Hypoallergenic infant formulas can be based on hydrolyzed proteins, which are proteins partially predigested in a less antigenic form. Other formulas, based on free amino acids, are the least antigenic and provide complete nutrition support in severe forms of milk allergy.
Seventy-five percent of children who have allergies to milk protein are able to tolerate baked-in milk products, ie., muffins, cookies, cake.
About 50% of children with allergies to milk, egg, soy, and wheat will outgrow their allergy by the age of 6. Those that don't, and those that are still allergic by the age of 12 or so, have less than an 8% chance of outgrowing the allergy.[38]
Peanut and tree nut allergies are less likely to be outgrown, although evidence now shows[39] that about 20% of those with peanut allergies and 9% of those with tree nut allergies[40] will outgrow their allergies. In such a case, they need to consume nuts in some regular fashion to maintain the non-allergic status.[citation needed] This should be discussed with a doctor.
Those with other food allergies may or may not outgrow their allergies.
[edit] Labeling laws
In response to the risk that certain foods pose to those with food allergies, countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or by-products of major allergens.
[edit] United States law
Under the Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282), companies are required to disclose on the label whether the product contains a major food allergen in clear, plain language. The allergens have to clearly be called out in the ingredient statement. Most companies list allergens in a statement separate from the ingredient statement.[41]
[edit] See also
Food portal
* Lactose intolerance
* Oral Allergy Syndrome
* Medical emergency
* Mast cell
For reasons that are not entirely understood, the diagnosis of food allergies has apparently become more common in Western nations in recent times.[4] In the United States food allergy affects as many as 5% of infants less than three years of age[26] and 3% to 4% of adults.[27] There is a similar prevalence in Canada.[28]
The most common food allergens include peanuts, milk, eggs, tree nuts, fish, shellfish, soy, and wheat - these foods account for about 90% of all allergic reactions.[citation needed]
[edit] Differing views
Various medical practitioners have a differing views on food allergies. Irritable Bowel Syndrome (IBS) patients have been studied with regards to food allergies. Some studies have reported on the role of food allergy in IBS; only one epidemiological study on functional dyspepsia and food allergy has been published. However, since 2005 several studies have demonstrated strong correlation between IgG and/or IgE food allergy and IBS symptoms[29][30][31] The mechanisms by which food activates mucosal immune system are incompletely understood, but food specific IgE and IgG4 appeared to mediate the hypersensitivity reaction in a subgroup of IBS patients. Specific chemicals and receptors have been demonstrated to be critical in food allergy development in murine models.[32] Exclusion diets based on skin prick test, RAST for IgE or IgG4, hypoallergic diet and clinical trials with oral disodium cromoglycate have been conducted, and some success has been reported in a subset of IBS patients.[33]
Studies comparing skin prick testing and ELISA blood testing have found that the results of skin prick testing correlate poorly with symptoms of irritable bowel syndrome that correlate with food allergies demonstrated through ELISA testing and dietary challenge.[34]
Extensive clinical experience has demonstrated significant improvement of patients with IBS whose ELISA-based food allergy testing is positive and where treatment includes a careful exclusion diet.[35]
In addition, many practitioners of alternative medicine ascribe symptoms to food allergy where other doctors do not. The causal relationships between some of these conditions and food allergies have not been studied extensively enough to provide sufficient evidence to become authoritative. The interaction of histamine with the nervous system receptors has been demonstrated, but more study is needed.[36] Other immune response effects are commonly known (swelling, irritation, etc.), but their relationships to some conditions has not been extensively studied. Examples are arthritis, fatigue, headaches, and hyperactivity. Nevertheless, hypoallergenic diets reportedly can be of benefit in these conditions, indicating that the current medical views on food allergy may be too narrow.
[edit] In children
Milk and soy allergies in children can often go undiagnosed for many months, causing much worry for parents and health risks for infants and children. Many infants with milk and soy allergies can show signs of colic, blood in the stool, mucous in the stool, reflux, rashes and other harmful medical conditions.[citation needed] These conditions are often misdiagnosed as viruses or colic.
Some children who are allergic to cow's milk protein also show a cross sensitivity to soy-based products.[37] There are infant formulas in which the milk and soy proteins are degraded so when taken by an infant, their immune system does not recognize the allergen and they can safely consume the product. Hypoallergenic infant formulas can be based on hydrolyzed proteins, which are proteins partially predigested in a less antigenic form. Other formulas, based on free amino acids, are the least antigenic and provide complete nutrition support in severe forms of milk allergy.
Seventy-five percent of children who have allergies to milk protein are able to tolerate baked-in milk products, ie., muffins, cookies, cake.
About 50% of children with allergies to milk, egg, soy, and wheat will outgrow their allergy by the age of 6. Those that don't, and those that are still allergic by the age of 12 or so, have less than an 8% chance of outgrowing the allergy.[38]
Peanut and tree nut allergies are less likely to be outgrown, although evidence now shows[39] that about 20% of those with peanut allergies and 9% of those with tree nut allergies[40] will outgrow their allergies. In such a case, they need to consume nuts in some regular fashion to maintain the non-allergic status.[citation needed] This should be discussed with a doctor.
Those with other food allergies may or may not outgrow their allergies.
[edit] Labeling laws
In response to the risk that certain foods pose to those with food allergies, countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or by-products of major allergens.
[edit] United States law
Under the Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282), companies are required to disclose on the label whether the product contains a major food allergen in clear, plain language. The allergens have to clearly be called out in the ingredient statement. Most companies list allergens in a statement separate from the ingredient statement.[41]
[edit] See also
Food portal
* Lactose intolerance
* Oral Allergy Syndrome
* Medical emergency
* Mast cell
food allergies
More rare food allergies
Likelihood of allergy can increase with exposure[citation needed]. For example, rice allergy is more common in East Asia where rice forms a large part of the diet.[13]
In Central Europe, celery allergy is more common. In Japan, allergy to buckwheat flour, used for Soba noodles, is more common.
Red meat allergy is extremely rare in the general population, but a geographic cluster of people allergic to red meat has been observed in Sydney, Australia.[14] There appears to be a possible association between localised reaction to tick bite and the development of red meat allergy.
Fruit allergies exist, such as to apples, pears, jackfruit, strawberries, etc.
Corn allergy may also be prevalent in many populations, although it may be difficult to recognize in areas such as the United States and Canada where corn derivatives are common in the food supply.[15]
[edit] Diagnosis
The best method for diagnosing food allergy is to be assessed by an allergist. The allergist will review the patient's history and the symptoms or reactions that have been noted after food ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, he/she will perform allergy tests.
Examples of allergy testing include:
* Skin prick testing is easy to do and results are available in minutes. Different allergists may use different devices for skin prick testing. Some use a "bifurcated needle", which looks like a fork with 2 prongs. Others use a "multi-test", which may look like a small board with several pins sticking out of it. In these tests, a tiny amount of the suspected allergen is put onto the skin or into a testing device, and the device is placed on the skin to prick, or break through, the top layer of skin. This puts a small amount of the allergen under the skin. A hive will form at any spot where the person is allergic. This test generally yields a positive or negative result. It is good for quickly learning if a person is allergic to a particular food or not, because it detects allergic antibodies known as IgE. Skin tests cannot predict if a reaction would occur or what kind of reaction might occur if a person ingests that particular allergen. They can however confirm an allergy in light of a patient's history of reactions to a particular food. Non-IgE mediated allergies cannot be detected by this method.
* Blood tests are another useful diagnostic tool for evaluating IgE-mediated food allergies. For example, the RAST (RadioAllergoSorbent Test)detects the presence of IgE antibodies to a particular allergen. A CAP-RAST test is a specific type of RAST test with greater specificity: it can show the amount of IgE present to each allergen.[16] Researchers have been able to determine "predictive values" for certain foods. These predictive values can be compared to the RAST blood test results. If a persons RAST score is higher than the predictive value for that food, then there is over a 95% chance the person will have an allergic reaction (limited to rash and anaphylaxis reactions) if they ingest that food.[citation needed] Currently, predictive values are available for the following foods: milk, egg, peanut, fish, soy, and wheat.[17][18][19] Blood tests allow for hundreds of allergens to be screened from a single sample, and cover food allergies as well as inhalants. However, non-IgE mediated allergies cannot be detected by this method.
* Food challenges, especially double-blind placebo-controlled food challenges (DBPCFC), are the gold standard for diagnosis of food allergies, including most non-IgE mediated reactions. Blind food challenges involve packaging the suspected allergen into a capsule, giving it to the patient, and observing the patient for signs or symptoms of an allergic reaction. Due to the risk of anaphylaxis, food challenges are usually conducted in a hospital environment in the presence of a doctor.
* Additional diagnostic tools for evaluation of eosinophilic or non-IgE mediated reactions include endoscopy, colonoscopy, and biopsy.
Important differential diagnoses are:
* Lactose intolerance; this generally develops later in life but can present in young patients in severe cases. This is due to an enzyme deficiency (lactase) and not allergy. It occurs in many non-Western people.
* Celiac disease; this is an autoimmune disorder triggered by gluten proteins such as gliadin (present in wheat, rye and barley). It is a non-IgE mediated food allergy by definition.
* Irritable bowel syndrome (IBS)
* C1 esterase inhibitor deficiency (hereditary angioedema); this rare disease generally causes attacks of angioedema, but can present solely with abdominal pain and occasional diarrhea.
[edit] Pathophysiology
For more details on this topic, see allergy.
Generally, introduction of allergens through the digestive tract is thought to induce immune tolerance. In individuals who are predisposed to developing allergies (atopic syndrome), the immune system produces IgE antibodies against protein epitopes on non-pathogenic substances, including dietary components.[citation needed] The IgE molecules are coated onto mast cells, which inhabit the mucosal lining of the digestive tract.
Upon ingesting an allergen, the IgE reacts with its protein epitopes and release (degranulate) a number of chemicals (including histamine), which lead to oedema of the intestinal wall, loss of fluid and altered motility. The product is diarrhea.[citation needed]
Any food allergy has the potential to cause a fatal reaction.
[edit] Causes
The immune system's eosinophils, once activated in a histamine reaction, will register any foreign proteins they see. One theory regarding the causes of food allergies focuses on proteins presented in the blood along with vaccines, which are designed to provoke an immune response. Influenza vaccines and the Yellow Fever vaccine are still egg-based, but the Measles-Mumps-Rubella vaccine stopped using eggs in 1994.[20] However large scientific studies do not support this theory, especially as it applies to autoimmune disease.[21]
Another theory focuses on whether an infant's immune system is ready for complex proteins in a new food when it is first introduced.[22]
One hypothesis at this time is the Hygiene hypothesis. While there is no proof for the hygiene hypothesis, people speculate[citation needed] that in modern, industrialized nations, such as the United States, food allergies are more common due to the lack of early exposure to dirt and germs, in part due to the over-use of antibiotics and antibiotic cleansers. This hypothesis is based partly on studies showing less allergy in third world countries.[citation needed] Some research suggests[citation needed] that the body, with less dirt and germs to fight off, turns on itself and attacks food proteins as if they were foreign invaders.
Antibiotics have also been implicated in Leaky Gut Syndrome which is another possible cause of food allergies[citation needed].
A lower incidence of food allergies in the developing world could also be due to differences in diet from the West and less exposure to food allergens.
Others have found that food allergies are due to widespread usage of baby skin-care products that contain allergens, such as lotions based upon peanut oil. These skin-care products are cheaper to manufacture than non-allergenic ones and using them sensitizes the baby, which later develops into a food allergy. This theory has yet to come with sufficient explanation as to why the occurrence of allergies has been on a steady rise in the last two decades.
[edit] Prevention
According to a report issued by the American Academy of Pediatrics, "There is evidence that breastfeeding for at least 4 months, compared with feeding infants formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood."[23]
[edit] Treatment
The mainstay of treatment for food allergy is avoidance of the foods that have been identified as allergens.
If the food is accidentally ingested and a systemic reaction occurs, then epinephrine (best delivered with an autoinjector of epinephrine such as an Epipen or Twinject) should be used. It is possible that a second dose of epinephrine may be required for severe reactions.[citation needed] The patient should also seek medical care immediately.
At this time, there is no cure for food allergies.[24] There are no allergy desensitization or allergy "shots" available for food allergies.[citation needed] Some doctors feel they do not work in food allergies because even minute amounts of the food in question or even food extracts (as in the case of allergy shots) can cause an allergic response in many sufferers.
Ronald van Ree of Amsterdam University expects that vaccines can in theory be created using genetic engineering to cure allergies. If this can be done, food allergies could be eradicated in about ten years.[25]
Likelihood of allergy can increase with exposure[citation needed]. For example, rice allergy is more common in East Asia where rice forms a large part of the diet.[13]
In Central Europe, celery allergy is more common. In Japan, allergy to buckwheat flour, used for Soba noodles, is more common.
Red meat allergy is extremely rare in the general population, but a geographic cluster of people allergic to red meat has been observed in Sydney, Australia.[14] There appears to be a possible association between localised reaction to tick bite and the development of red meat allergy.
Fruit allergies exist, such as to apples, pears, jackfruit, strawberries, etc.
Corn allergy may also be prevalent in many populations, although it may be difficult to recognize in areas such as the United States and Canada where corn derivatives are common in the food supply.[15]
[edit] Diagnosis
The best method for diagnosing food allergy is to be assessed by an allergist. The allergist will review the patient's history and the symptoms or reactions that have been noted after food ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, he/she will perform allergy tests.
Examples of allergy testing include:
* Skin prick testing is easy to do and results are available in minutes. Different allergists may use different devices for skin prick testing. Some use a "bifurcated needle", which looks like a fork with 2 prongs. Others use a "multi-test", which may look like a small board with several pins sticking out of it. In these tests, a tiny amount of the suspected allergen is put onto the skin or into a testing device, and the device is placed on the skin to prick, or break through, the top layer of skin. This puts a small amount of the allergen under the skin. A hive will form at any spot where the person is allergic. This test generally yields a positive or negative result. It is good for quickly learning if a person is allergic to a particular food or not, because it detects allergic antibodies known as IgE. Skin tests cannot predict if a reaction would occur or what kind of reaction might occur if a person ingests that particular allergen. They can however confirm an allergy in light of a patient's history of reactions to a particular food. Non-IgE mediated allergies cannot be detected by this method.
* Blood tests are another useful diagnostic tool for evaluating IgE-mediated food allergies. For example, the RAST (RadioAllergoSorbent Test)detects the presence of IgE antibodies to a particular allergen. A CAP-RAST test is a specific type of RAST test with greater specificity: it can show the amount of IgE present to each allergen.[16] Researchers have been able to determine "predictive values" for certain foods. These predictive values can be compared to the RAST blood test results. If a persons RAST score is higher than the predictive value for that food, then there is over a 95% chance the person will have an allergic reaction (limited to rash and anaphylaxis reactions) if they ingest that food.[citation needed] Currently, predictive values are available for the following foods: milk, egg, peanut, fish, soy, and wheat.[17][18][19] Blood tests allow for hundreds of allergens to be screened from a single sample, and cover food allergies as well as inhalants. However, non-IgE mediated allergies cannot be detected by this method.
* Food challenges, especially double-blind placebo-controlled food challenges (DBPCFC), are the gold standard for diagnosis of food allergies, including most non-IgE mediated reactions. Blind food challenges involve packaging the suspected allergen into a capsule, giving it to the patient, and observing the patient for signs or symptoms of an allergic reaction. Due to the risk of anaphylaxis, food challenges are usually conducted in a hospital environment in the presence of a doctor.
* Additional diagnostic tools for evaluation of eosinophilic or non-IgE mediated reactions include endoscopy, colonoscopy, and biopsy.
Important differential diagnoses are:
* Lactose intolerance; this generally develops later in life but can present in young patients in severe cases. This is due to an enzyme deficiency (lactase) and not allergy. It occurs in many non-Western people.
* Celiac disease; this is an autoimmune disorder triggered by gluten proteins such as gliadin (present in wheat, rye and barley). It is a non-IgE mediated food allergy by definition.
* Irritable bowel syndrome (IBS)
* C1 esterase inhibitor deficiency (hereditary angioedema); this rare disease generally causes attacks of angioedema, but can present solely with abdominal pain and occasional diarrhea.
[edit] Pathophysiology
For more details on this topic, see allergy.
Generally, introduction of allergens through the digestive tract is thought to induce immune tolerance. In individuals who are predisposed to developing allergies (atopic syndrome), the immune system produces IgE antibodies against protein epitopes on non-pathogenic substances, including dietary components.[citation needed] The IgE molecules are coated onto mast cells, which inhabit the mucosal lining of the digestive tract.
Upon ingesting an allergen, the IgE reacts with its protein epitopes and release (degranulate) a number of chemicals (including histamine), which lead to oedema of the intestinal wall, loss of fluid and altered motility. The product is diarrhea.[citation needed]
Any food allergy has the potential to cause a fatal reaction.
[edit] Causes
The immune system's eosinophils, once activated in a histamine reaction, will register any foreign proteins they see. One theory regarding the causes of food allergies focuses on proteins presented in the blood along with vaccines, which are designed to provoke an immune response. Influenza vaccines and the Yellow Fever vaccine are still egg-based, but the Measles-Mumps-Rubella vaccine stopped using eggs in 1994.[20] However large scientific studies do not support this theory, especially as it applies to autoimmune disease.[21]
Another theory focuses on whether an infant's immune system is ready for complex proteins in a new food when it is first introduced.[22]
One hypothesis at this time is the Hygiene hypothesis. While there is no proof for the hygiene hypothesis, people speculate[citation needed] that in modern, industrialized nations, such as the United States, food allergies are more common due to the lack of early exposure to dirt and germs, in part due to the over-use of antibiotics and antibiotic cleansers. This hypothesis is based partly on studies showing less allergy in third world countries.[citation needed] Some research suggests[citation needed] that the body, with less dirt and germs to fight off, turns on itself and attacks food proteins as if they were foreign invaders.
Antibiotics have also been implicated in Leaky Gut Syndrome which is another possible cause of food allergies[citation needed].
A lower incidence of food allergies in the developing world could also be due to differences in diet from the West and less exposure to food allergens.
Others have found that food allergies are due to widespread usage of baby skin-care products that contain allergens, such as lotions based upon peanut oil. These skin-care products are cheaper to manufacture than non-allergenic ones and using them sensitizes the baby, which later develops into a food allergy. This theory has yet to come with sufficient explanation as to why the occurrence of allergies has been on a steady rise in the last two decades.
[edit] Prevention
According to a report issued by the American Academy of Pediatrics, "There is evidence that breastfeeding for at least 4 months, compared with feeding infants formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood."[23]
[edit] Treatment
The mainstay of treatment for food allergy is avoidance of the foods that have been identified as allergens.
If the food is accidentally ingested and a systemic reaction occurs, then epinephrine (best delivered with an autoinjector of epinephrine such as an Epipen or Twinject) should be used. It is possible that a second dose of epinephrine may be required for severe reactions.[citation needed] The patient should also seek medical care immediately.
At this time, there is no cure for food allergies.[24] There are no allergy desensitization or allergy "shots" available for food allergies.[citation needed] Some doctors feel they do not work in food allergies because even minute amounts of the food in question or even food extracts (as in the case of allergy shots) can cause an allergic response in many sufferers.
Ronald van Ree of Amsterdam University expects that vaccines can in theory be created using genetic engineering to cure allergies. If this can be done, food allergies could be eradicated in about ten years.[25]
Food allergy
The food protein triggering the allergic response is termed a food allergen. It is estimated that up to 12 million Americans have food allergies,[3] and the prevalence is rising.[4] Six to eight percent of children under the age of three have food allergies and nearly four percent of adults have them.[5] Food allergies cause roughly 30,000 emergency room visits and 100 to 200 deaths per year in the United States.[6] The most common food allergies in adults are shellfish, peanuts, tree nuts, fish, and eggs,[5] and the most common food allergies in children are milk, eggs, peanuts, and tree nuts.[5]
Treatment consists of avoidance diets, in which the allergic person avoids all forms of the food to which they are allergic. For people who are extremely sensitive, this may involve the total avoidance of any exposure with the allergen, including touching or inhaling the problematic food as well as touching any surfaces that may have come into contact with it. Areas of research include anti-IgE antibody (omalizumab, or Xolair) and specific oral tolerance induction (SOTI), which have shown some promise for treatment of certain food allergies. People diagnosed with a food allergy may carry an autoinjector of epinephrine such as an EpiPen or Twinject, wear some form of medical alert jewelry, or develop an emergency action plan, in accordance with their doctor.
Signs and symptoms
Classic immunoglobulin-E (IgE)-mediated food allergies are classified as type-I immediate hypersensitivity reactions. These allergic reactions have an acute onset (from seconds to one hour) and may include
* Angioedema: soft tissue swelling, usually involving the eyelids, face, lips, and tongue. Angioedema may result in severe swelling of the tongue as well as the larynx (voice box) and trachea, resulting in upper airway obstruction and difficulty breathing.
* Hives
* Itching of the mouth, throat, eyes, skin
* Nausea, vomiting, diarrhea, stomach cramps, and/or abdominal pain. This group of symptoms is termed gastrointestinal hypersensitivity or anaphylaxis.
* Rhinorrhea, nasal congestion
* Wheezing, scratchy throat, shortness of breath, or difficulty swallowing
* Anaphylaxis: a severe, whole-body allergic reaction that can result in death (see below)
The reaction may progress to anaphylactic shock: A systemic reaction involving several different bodily systems including hypotension (low blood pressure),loss of consciousness, and possibly death. Allergens most frequently associated with this type of reaction are peanuts, nuts, milk, egg, and seafood, though many food allergens have been reported as triggers for anaphylaxis.
Food allergy is thought to develop more easily in patients with the atopic syndrome, a very common combination of diseases: allergic rhinitis and conjunctivitis, eczema and asthma.[8] The syndrome has a strong inherited component; a family history of allergic diseases can be indicative of the atopic syndrome.
Conditions caused by food allergies are classified into 3 groups according to the mechanism of the allergic response:
1. IgE-mediated (classic):
* Type-I immediate hypersensitivity reaction (symptoms described above)
* Oral allergy syndrome
2. IgE and/or non-IgE-mediated:
* Allergic eosinophilic esophagitis
* Allergic eosinophilic gastritis
* Allergic eosinophilic gastroenteritis
3. Non-IgE mediated:
* Food protein-induced Enterocolitis syndrome (FPIES)
* Food protein proctocolitis/proctitis
* Food protein-induced enteropathy. An important example is Coeliac disease, which is an adverse immune response to the protein gluten.
* Milk-soy protein intolerance (MSPI) is a non-medical term used to describe a non-IgE mediated allergic response to milk and/or soy protein during infancy and early childhood. Symptoms of MSPI are usually attributable to food protein proctocolitis or FPIES.
* Heiner syndrome - lung disease due to formation of milk protein/IgG antibody immune complexes (milk precipitins) in the blood stream after it is absorbed from the GI tract. The lung disease commonly causes bleeding into the lungs and results in pulmonary hemosiderosis.
[edit] The big eight
The most common food allergies are:[9]
* Dairy allergy
* Egg allergy
* Peanut allergy
* Tree nut allergy
* Seafood allergy
* Shellfish allergy
* Soy allergy
* Wheat allergy
These are often referred to as "the big eight."[10] They account for over 90% of the food allergies in the United States.[11]
The top allergens vary somewhat from country to country but milk, eggs, peanuts, treenuts, fish, shellfish, soy, wheat and sesame tend to be in the top 10 in many countries.[citation needed] Allergies to seeds - especially sesame - seem to be increasing in many countries.[12]
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