Many people assign their variety of symptoms to food, and many such victims are seen and started on exclusion diets. The scientific proof that food does damage in most instances is feeble, although unfavorable reactions to food definitely exist. These can be classified into those that involve immune mechanisms as “food allergy” and those that do not involve immune mechanism as “food intolerance”.
Food allergy
Food allergy affect up to about 5% of young children and about 1-2% of adults. This form of allergy may be IgE mediated or non-IgE mediated (T-cell mediated). The IgE mediated reactions occurs within minutes or hour after the ingestion of the food . Adults are more likely to be allergic to fish, shellfish and peanuts, while young children are mostly allergic to cow's milk, egg white, wheat, and soy. Peanuts are very allergenic and when it is there it persists throughout life. The following conditions can result from food allergy
Acute hypersensitivity: After ingestion of nuts, strawberries or shellfish the patient suffers from urticaria , vomiting and diarrhea. These normally don’t pose much problem as the patients are aware and learn to avoid the suspected food. Unintentional eating of the incriminating foodstuff can sometimes occur, leading to angioneurotic oedema, a life threatening condition.
Eczema and asthma: Mostly IgE mediated and affect the children.
Rhinitis and asthma: In the atopic individuals these are mostly produced by milk and chocolates.
Chronic urticaria: Exclusion of particular food releive the problem in most patients
Food-sensitive enteropathy: Coeliac disease (gluten (wheat) sensitive enteropathy), and cow's milk enteropathy (in infants) are the example of this reaction.
Food intolerance
Migraine: Intake of foods like chocolate, cheese and alcohol Some patients suffer from migraine. These foods are rich in certain amines, such as tyramine, which are responsible for such attacks. Those on monoamine oxidase inhibitors, which are involved in the metabolism of these amines, are particularly susceptible.
Irritable bowel syndrome: Though mechanism not clearly understood, certain food precipitates the attack of IBS following ingestion of certain food items, such as wheat.
Chinese restaurant syndrome: dizziness, faintness, nausea, sweating and chest pains may follow after ingestion of Chinese food in some. The responsible agent is Monosodium glutamate, a flavoring agent used in cooking Chinese food.
Lactose intolerance: Abdominal bloating and diarrhea following intake of milk is probably the commonest form of food intolerance all over the world. Lactose present in the milk is the causative factor. This may be genetic in origin
Phenylketonuria: This is also a type of food intolerance, and is due to missing phenylalanine hydroxylase, which is essential for the metabolism of phenylalanine in the protein of the diet
There are other genetic errors of metabolism, which can be regarded as forms of food intolerance.
Food intolerance can occur:
To any constituent of food like the histamine in mackerel or canned food, or the tyramine in cheese.
Or,
Chemical mediators released by food stuff like histamine may be released by tomatoes or strawberries.
Or,
Toxic chemicals present in food like the food additive tartrazine.
Though sometimes thought, there are no evidence to prove that conditions such as arthritis, behavior and affective disorders and Crohn's disease are because of certain type of food ingestion. Multiple vague symptoms such as tiredness or malaise as sometimes blamed are not due to food allergy. Mostly, these patients are victim of some form of psychiatric disorder.
Treatment of food allergies and intolerance:
A careful history may help to outline the contributory mediator, particularly when the effects are instant.
Skin-prick testing with allergen, measurement of antigen or antibodies in the do not correlate with the symptoms and results are usually misleading. 'Fringe' techniques like hair analysis, has negligible value, though advised widely.
Diagnostic exclusion diets are useful but very time-consuming. They can sporadically be of value in recognizing a particular food causing allergy or intolerance.
Dietary challenge is a method where food and the test being given sublingually or by inhalation in an attempt to reproduce the symptoms. Again this may be helpful in small number of cases.
Most people who have acute allergies to food identify it and stop taking the food, and do not usually require medical treatment. In rest of the patients, a small number seem to be helped by modifying their diet, but there is no good scientific substantiation to prove these exclusion diets.
Showing posts with label Fibromyalgia. Show all posts
Showing posts with label Fibromyalgia. Show all posts
Thursday, April 2, 2009
Wednesday, March 11, 2009
Fibromyalgia - Diagnosis and Treatment
Summary of features of Fibromyalgia
This disease is mainly found in women aged 20 to 50. Chronic generalized musculoskeletal pain with multiple tender areas are the important feature. Fibromyalgia is also associated with fatigue, headaches, numbness. There are no signs of inflammation and all the laboratory studies normal. Fibromyalgia partially responds to exercise, tricyclic antidepressants.
What is Fibromyalgia?
Fibromyalgia is one of the commonest rheumatic diseases involves 3 to 10% of the general population. It has in common a lot of features with the chronic fatigue syndrome, like both have increased incidence among women aged 20 to 50, absence of any inflammation or, objective findings, and no abnormal diagnostic laboratory test findings. Differential features are musculoskeletal pain is the important complain in fibromyalgia while lassitude dominates the chronic fatigue syndrome.
The cause of fibromyalgia is unidentified, but sleep disorders, depression, viral infections, and abnormal sensitivity to pain are some of the probable explanations. Fibromyalgia sometimes appears rarely as a complication of hypothyroidism, rheumatoid arthritis. In men it is sometimes a consequence of sleep apnoea.
What are the symptoms and examination findings of fibromyalgia?
The affected person complains of continual ache and inflexibility, commonly involving the whole body but particularly around the neck, shoulders, low back, and hips. This pain is commonly associated with lassitude, sleeping problems, numbness, chronic headaches, and irritable bowel symptoms (IBS). Even slight effort aggravates pain and increases the fatigue. When the patient is examined physically everything usually comes out as normal except there are some "trigger points" where pain produced by light pressure in various area of the body like shoulder blades, the medial fat pad of the knee, and the lateral aspects of the elbow.
Diagnosis of Fibromyalgia
Fibromyalgia is diagnosed by excluding all other possible causes. The detailed history from the patient usually help the doctor to skip many costly investigations. Rheumatoid arthritis and systemic lupus erythematosus (SLE) are two important diseases are excluded as both of them presents woth objective clinical findings and abnormal laboratory tests like ESR and C-reactive protein. Thyroid function tests is done as hypothyroidism can sometimes cause a secondary fibromyalgia syndrome. Polymyositis, another condition to be differentiated from fibromyalgia, produces mainly weakness rather than pain. The diagnosis of fibromyalgia probably should be with caution in a patient over age 50 and should not be accounted for any fever, weight loss, or other objective findings. Polymyalgia rheumatic is a condition appears after the age of 50 and causes shoulder and pelvic girdle pain. This is also associated with anemia and high ESR value.. Oncogenic osteomalacia, a Hypophosphatemic is differentiate from fibromyalgia by the low phosphate laevel and pain in fewer areas.
Treatment of fibromyalgia
Counseling and education is the mainstay of the treatment. Sufferes can be reassured that they have a diagnosable condition and is treatable. They must be assured that the course of the disease is not progressive.
Modest results are expected from amitriptyline, fluoxetine, chlorpromazine, or cyclobenzaprine. Amitriptyline is started at a dosage of 10 mg tab orally at bedtime and step by step increased to 40–50 mg depending on result and side effects. Less than half of the patients find a persistent improvement. Exercise programs are also advantageous. NSAIDs generally do not wok in this case. Tramadol and acetaminophen combinations reported some good results in short trials. Opioids and corticosteroids should not be used as they are ineffective. Acupuncture also could not prove its efficacy.
This disease is mainly found in women aged 20 to 50. Chronic generalized musculoskeletal pain with multiple tender areas are the important feature. Fibromyalgia is also associated with fatigue, headaches, numbness. There are no signs of inflammation and all the laboratory studies normal. Fibromyalgia partially responds to exercise, tricyclic antidepressants.
What is Fibromyalgia?
Fibromyalgia is one of the commonest rheumatic diseases involves 3 to 10% of the general population. It has in common a lot of features with the chronic fatigue syndrome, like both have increased incidence among women aged 20 to 50, absence of any inflammation or, objective findings, and no abnormal diagnostic laboratory test findings. Differential features are musculoskeletal pain is the important complain in fibromyalgia while lassitude dominates the chronic fatigue syndrome.
The cause of fibromyalgia is unidentified, but sleep disorders, depression, viral infections, and abnormal sensitivity to pain are some of the probable explanations. Fibromyalgia sometimes appears rarely as a complication of hypothyroidism, rheumatoid arthritis. In men it is sometimes a consequence of sleep apnoea.
What are the symptoms and examination findings of fibromyalgia?
The affected person complains of continual ache and inflexibility, commonly involving the whole body but particularly around the neck, shoulders, low back, and hips. This pain is commonly associated with lassitude, sleeping problems, numbness, chronic headaches, and irritable bowel symptoms (IBS). Even slight effort aggravates pain and increases the fatigue. When the patient is examined physically everything usually comes out as normal except there are some "trigger points" where pain produced by light pressure in various area of the body like shoulder blades, the medial fat pad of the knee, and the lateral aspects of the elbow.
Diagnosis of Fibromyalgia
Fibromyalgia is diagnosed by excluding all other possible causes. The detailed history from the patient usually help the doctor to skip many costly investigations. Rheumatoid arthritis and systemic lupus erythematosus (SLE) are two important diseases are excluded as both of them presents woth objective clinical findings and abnormal laboratory tests like ESR and C-reactive protein. Thyroid function tests is done as hypothyroidism can sometimes cause a secondary fibromyalgia syndrome. Polymyositis, another condition to be differentiated from fibromyalgia, produces mainly weakness rather than pain. The diagnosis of fibromyalgia probably should be with caution in a patient over age 50 and should not be accounted for any fever, weight loss, or other objective findings. Polymyalgia rheumatic is a condition appears after the age of 50 and causes shoulder and pelvic girdle pain. This is also associated with anemia and high ESR value.. Oncogenic osteomalacia, a Hypophosphatemic is differentiate from fibromyalgia by the low phosphate laevel and pain in fewer areas.
Treatment of fibromyalgia
Counseling and education is the mainstay of the treatment. Sufferes can be reassured that they have a diagnosable condition and is treatable. They must be assured that the course of the disease is not progressive.
Modest results are expected from amitriptyline, fluoxetine, chlorpromazine, or cyclobenzaprine. Amitriptyline is started at a dosage of 10 mg tab orally at bedtime and step by step increased to 40–50 mg depending on result and side effects. Less than half of the patients find a persistent improvement. Exercise programs are also advantageous. NSAIDs generally do not wok in this case. Tramadol and acetaminophen combinations reported some good results in short trials. Opioids and corticosteroids should not be used as they are ineffective. Acupuncture also could not prove its efficacy.
Subscribe to:
Posts (Atom)