Food hypersensitivities, medication

The value of the medical history depends largely on the patient s recollection of symptoms and examiner s ability to differentiate between disorders provoked by food hypersensitivity and those with other causes (Burks and Sampson, 1992 Chapman et al., 2006). 

Table 4.3 Selected food hypersensitivity and medication errors...

Selected food hypersensitivity and medication interaction mainly due to one or more excipients may also preclude use of certain medications as listed in Table 4.3. 

A severe type I hypersensitivity reaction such as systemic anaphylaxis (eg, from insect envenomation, ingestion of certain foods, or drug hypersensitivity) requires immediate medical intervention. 

Aspirin is known to cause serious reactions in certain patients with asthma (Cooke 1919). The patients can also have rhinorrhea and nasal polyps that may precede the bronchoconstrictor type of intolerance to aspirin for months or years. This triad of symptoms is common in middle-aged women. The aspirin-sensitive patients often show intolerance to other analgesics (Smith 1971). Speer (1958) reported that color additives can precipitate asthma. Aspirin-sensitive patients with asthma also cross-react to tartrazine in 8%-15% of the cases (Chafee and Setti-PANE 1967 Samter and Beers 1967 Hosen 1972 Settipane and Pudupakkam 1975 Delaney 1976) and to various benzoates (Juhlin et al. 1972 Rosenhall and Zetterstrom 1973). Hypersensitivity to food colorants, preservatives, and analgesics was studied in 504 patients with asthma and rhinitis by Rosenhall (1977). Hypersensitivity to at least one of the substances was found in 106 patients. In 33 patients sensitive to tartrazine 42% were intolerant to aspirin and 39% to sodium benzoate. Rosenhall also tested his patients with other azo dyes such as Sunset Yellow and New Coccine as well as the non-azo dyes carmine and patent blue. The method of examination and reproducibility of the results were studied in detail. Dietary treatment was found to be effective in some patients in preventing exacerbations of the disease but on the whole had no influence on the course of the disease or the need for medication. 

This process includes dietary, anthropometric, and biochemical aspects. Nutritional assessment begins with a detailed nutritional history that includes clinical, dietary, socioeconomic, and family issues. Areas of interest include present and past illnesses, family illness history, food allergies or intolerance, medications, nutritional supplements, over-the-counter medications, alcohol use, work environment, and education level. A useful standardized protocol is the Prognostic Nutritional Index (PNI), which incorporates serum albumin, serum transferrin, delayed skin hypersensitivity, and triceps skinfold thickness (20,21). The PNI has been shown to correlate with postoperative complications and mortality (22). Whole body functional assessment by examining overall activity, exercise tolerance, grip strength, respiratory function, wound healing, and plasma albumin concentration can also be useful. 

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