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Table II-1. Signs and Symptoms of Allergic Reactions to Food

C

Skin

U T A N E O U S

Oral cavity (lips, tongue, palate) Eyes, conjunctiva

GASTROINTESTINAL

R E S P I R A T O R Y

Nose Larynx, throat

Lungs

HEART and CARDIOVASCULAR

OTHER

Pruritus (Itching) Pruritus (Itching), dryness/tightness

Nasal congestion or runniness, sneezing Swelling around the larynx and vocal cord, voice hoarseness, stridor (inspiratory wheeze), cough

Shortness of breath, chest pain/tightness

Respiratory distress (i.e., breathing rate,

difficulty catching breath, peak expiratory flow measurement), cough, wheezing

Subjective Symptoms

Objective Signs

Pruritus (Itching)

Skin flushing or erythema (redness)

Pilor erection (“goosebumps”) Rash: Urticaria (hives) - acute

Pruritus (Itching), numbness, dryness Pruritus (Itching)

Eczema (usually delayed, >6 hours) Angioedema (swelling, especially face) Edema (swelling, may also include the uvula) Periorbital (around eyes) edema, redness of conjunctiva and tearing

Nausea, pain (except infants/young child)

Vomiting, diarrhea, abdominal pain (infants)

Chest pain/ tightness, feeling of faintness, dizziness

Syncope (fainting, loss of consciousness), hypotension (low) or shock (very low blood pressure), dysrhythmia (abnormal heart rhythm)

“Sense of impending doom”

Uterine contractions (women)

The severity of an allergic reaction is affected by several factors that include genetic predisposition (atopy), age, type of food allergen, nature of any food processing, environment, and physiological conditions (Taylor and Hefle, 2001; Sampson, 2003; Maleki, 2004). For example, exercise, medications (e.g., non-steroidal anti- inflammatories), alcohol consumption, and asthma may enhance the severity of an allergic reaction (Sampson, 2005). Most severe and fatal allergic reactions to foods have occurred in adolescents and teens whom were highly atopic and had a history of asthma (Sampson, 2003; Pumphrey, 2004).

It is generally assumed that a history of previous serious allergic reaction(s) indicates an increased risk of future severe reaction(s). However, a history of mild reactions does not preclude the possibility of a future severe reaction. For example, Sicherer et al. (1998) observed that mild reactions to peanut in childhood tend to become more severe and

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