Allergie e intolleranze alimentari
Table of Contents
Gli alimenti possono essere causa di reazioni avverse, distinguibili in forme immunomediate, allergie alimentari e non immunomediate intolleranze alimentari.
L’allergia alimentare è una reazione immunomediata, che si manifesta ripetitivamente dopo l’esposizione a un determinato alimento e scompare dopo la sua eliminazione. Alla risposta immune a tale alimento può essere IgE mediata, non IgE mediata oppure mista. Nella forma IgE mediata sono presenti la sensibilizzazione verso un allergene alimentare con lo sviluppo di anticorpi di classe IgE e, secondariamente, lo sviluppo di segni e sintomi successivi all’assunzione di quel determinato alimento. Nelle forme e non IgE mediata predomina un processo immunologico mediato dai linfociti T. Le intolleranze alimentari sono invece manifestazioni avverse ad alcuni alimenti che non si basano su una reazione allergica, in quanto il sistema immune non
è coinvolto. Alcune intolleranze alimentari si manifestano come conseguenza di un deficit enzimatico, come quello della lattasi.
Allergie alimentari
Tra i fattori che potrebbero avere un effetto sull’esordio dell’allergia alimentare sono inclusi il momento di introduzione degli alimenti, la via di esposizione agli allergeni alimentari e l’esposizione a fattori microbiotici. La mancata esposizione precoce ad agenti virali, batterici e a parassiti sembrerebbe aumentare il rischio di atopia (predisposizione genetica allo sviluppo di reazioni da ipersensibilità immediata contro antigeni ambientali).
Patogenesi clinica
La produzione di IgE specifiche è necessaria alla reazione allergica, tuttavia la loro presenza non significa che l’individuo debba sicuramente sviluppare una reazione allergica a quel determinato allergene. Le IgE si legano alla superficie dei mastociti a livello tessutale o agli eosinofili circolanti attraverso un recettore ad alta affinità per le IgE, l’ FcERI. Dopo l’assunzione di un alimento si crea un legame tra allergene alimentare e le IgE dei mastociti e degli eosinofili che induce la degranulazione di queste cellule effettrici. La diretta conseguenza è la liberazione di istamina, leucotrieni e altri mediatori responsabili dei sintomi di allergia.
I quadri clinici possibili possono essere;
. angioedema;
. sindrome orale allergica (prurito del cavo orofaringeo, edema labiale);
. diarrea e o dolore addominale;
. nausea e vomito;
. prurito e orticaria;
. asma, rinite, tosse, otite, congiuntivite;
. ipotensione fino allo shock anafilattico.
Diagnosi
Il primo step prevede la differenziazione delle forme IgE mediate da quelle non IgE mediate; nelle forme IgE mediate i sintomi più comuni riguardano l'apparato respiratorio, cutaneo e digerente mentre sintomi neurologici e lo shock anafilattico sono più rari.
La tempistica di presentazione varia normalmente da pochi minuti
a circa due ore successive all'ingestione di un determinato alimento. Ma gli alimenti che più frequentemente generato questo tipo di reazioni sono nel bambino latte, uova, nocciole, mentre nel giovane adulto sono arachidi, noci, crostacei e molluschi. I sintomi si risolvono dopo poche ore dall'inizio della sintomatologia. Tuttavia, vi possono essere reazioni bifasiche o tardive, che possono manifestarsi anche dopo diverso tempo, fino a 6 ore dopo l'assunzione dell'alimento che si risolvono il rapidamente, come nel caso della sensibilizzazione a zuccheri contenuti nelle carni di mammiferi. Occorre raccogliere un' attenta storia alimentare che comprenda possibilmente una lista di alimenti o ingredienti ritenuti dal paziente responsabili della reazione allergica. Poiché è sufficiente una piccola quantità di allergene a indurre una reazione allergica, è necessario valutare anche un'eventuale contaminazione del cibo. Il consumo di alcol o di antinfiammatori non steroidi deve essere sempre indagato in quanto alcuni pazienti sviluppano la reazione allergica solo in concomitanza dell'assunzione dell' alimento associato a uno di questi due fattori. L'iter diagnostico si avvale di esami di laboratorio di vario tipo che confermano la presenza dell' allergia alimentare ne individuano l'agente eziologico. I primi ad essere utilizzati sono i prick test di provocazione cutanea che consistono nell' inoculazione all'interno della cute di estratti alimentari standardizzati. Un altro test utile per individuare IgE specifiche contro un determinato alimento è la ricerca degli anticorpi in vitro (RAST).
Terapia e prevenzione
L'eliminazione totale dalla dieta dell'alimento che causa la reazione allergica è il principio terapeutico fondamentale. Inoltre recenti studi hanno proposto un approccio terapeutico attraverso
l' immunoterapia orale che, attraverso l'introduzione graduale dell'allergene secondo fasi protocollate, indurrebbe
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With Out PCT, it takes longer for your hormones to return to regular,
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Sadly, Vitamin B6 is simply effective with low Nandrolone doses.
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Steroids have a powerful anti-catabolic impact on muscular tissues (after all,
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Clomid (Clomiphene) is a Selective Estrogen Receptor Modulator (SERM) often used as PCT.
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