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Allergy and Immunology Milestones
Allergy and Immunology Milestones The Accreditation Council for Graduate Medical Education Second Revision: August 2019 First Revision: August 2013 Allergy and Immunology Milestones The Milestones are designed only for use in evaluation of residents in the context of their participation in ACGME-accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the resident in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context. i Allergy and Immunology Milestones Work Group Amal Assa’ad, MD Evelyn Lomasney, MD Taylor Atchley, MD Aidan Long, MD T. Prescott Atkinson, MD, PhD Mike Nelson, MD Laura Edgar, EdD, CAE Princess Ogbogu, MD Beverly Huckman, BA* Kelly Stone, MD, PhD Bruce Lanser, MD The ACGME would like to thank the following organizations for their continued support in the development of the Milestones: American Board of Allergy and Immunology American Academy of Allergy, Asthma, and Immunology Review Committee for Allergy and Immunology *Acknowledgments: The Work Group and the ACGME would like to honor Beverly Huckman, for her contributions as the non-physician member of the milestones work group. She will be greatly missed. ii Understanding Milestone Levels and Reporting This document presents the Milestones, which programs use in a semi-annual review of resident performance, and then report to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a developmental framework. -
Graft-Versus-Host Disease Cells Suppresses Development Of
Adenosine A2A Receptor Agonist −Mediated Increase in Donor-Derived Regulatory T Cells Suppresses Development of Graft-versus-Host Disease This information is current as of September 28, 2021. Kyu Lee Han, Stephenie V. M. Thomas, Sherry M. Koontz, Cattlena M. Changpriroa, Seung-Kwon Ha, Harry L. Malech and Elizabeth M. Kang J Immunol 2013; 190:458-468; Prepublished online 7 December 2012; Downloaded from doi: 10.4049/jimmunol.1201325 http://www.jimmunol.org/content/190/1/458 http://www.jimmunol.org/ References This article cites 52 articles, 20 of which you can access for free at: http://www.jimmunol.org/content/190/1/458.full#ref-list-1 Why The JI? Submit online. • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists by guest on September 28, 2021 • Fast Publication! 4 weeks from acceptance to publication *average Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. The Journal of Immunology Adenosine A2A Receptor Agonist–Mediated Increase in Donor-Derived Regulatory T Cells Suppresses Development of Graft-versus-Host Disease Kyu Lee Han,* Stephenie V. M. Thomas,* Sherry M. -
Food Intolerance
Food intolerance A food intolerance is when the body reacts to a food but the reaction doesn’t involve the immune system. Symptoms Diagnoses Symptoms of intolerance can include The 'elimination diet' is the only way to bloating and wind, diarrhoea, nausea, diagnose a food intolerance. All suspected indigestion, eczema and asthma. foods are completely removed from the diet for one to three weeks. Unlike food allergies most food intolerances are dose-dependent, A small amount is then reintroduced and meaning that a person can usually if symptoms reoccur, the intolerance is consume a certain amount before confirmed. symptoms appear. It is important that this test is taken under the supervision of a doctor, allergy specialist or Registered Dietitian to make sure that proper nutrition is maintained. Source: Allergy New Zealand, a national not-for-profit society whose primary role is to provide information, education, and support to the many thousands of New Zealanders living with allergies, including those at risk of anaphylaxis. For more information phone 09 623 3912 or email [email protected]. Food intolerance Almost any food can cause an intolerance, but there are some types of intolerances that occur more than others. Lactose intolerance This condition is called coeliac disease. It involves the immune system and is not an A condition in which a person cannot digest intolerance. the sugar found in dairy products, is one of the most common food intolerances. It is estimated that 1 in Sensitivity to naturally occurring food chemicals can cause symptoms of 100 New Zealanders are intolerance as well. -
Food Fact Sheet: Food Allergy and Food Intolerance
Food Fact Sheet: Food Allergy and Food Intolerance Having to avoid certain foods in your diet can be difficult. But there are a few simple things you can do to help you manage your food allergies - allowing you to stay safe, continue to participate in fun activities and enjoy your food. What is the difference between food allergy and food intolerance? For some people, eating certain foods can lead to an unpleasant and sometimes dangerous physical reaction. The term used to describe all types of reactions to foods is ‘food hypersensitivity’. A 'food allergy' is a reaction involving the immune system (the body’s defence against foreign bodies). Those that do not involve the immune system are often called a ‘food intolerance’. It is important to identify and manage foods that trigger any symptoms in an appropriate way. Food allergy Proteins within foods can trigger immediate (within two hours) or delayed symptoms (up to several days later). Immediate food allergy (IgE mediated food allergy) Immediate reactions to foods occur when your immune system reacts to a normally harmless protein in food, due to the creation of Immunoglobulin E (IgE). This results in the release of chemicals (e.g. histamine) which trigger allergic symptoms. These symptoms are usually in the skin (itching/swelling), or gut (vomiting, diarrhoea). Other symptoms can include breathing problems and in rare cases an extreme allergic reaction called anaphylaxis. Delayed food allergy (non IgE mediated food allergy) Delayed reactions to foods still involve your immune system, but there is a different type of immune reaction involved. Symptoms typically occur in the gut (vomiting, diarrhoea, constipation) and/or the skin (atopic eczema). -
Hypersensitivity Reactions (Types I, II, III, IV)
Hypersensitivity Reactions (Types I, II, III, IV) April 15, 2009 Inflammatory response - local, eliminates antigen without extensively damaging the host’s tissue. Hypersensitivity - immune & inflammatory responses that are harmful to the host (von Pirquet, 1906) - Type I Produce effector molecules Capable of ingesting foreign Particles Association with parasite infection Modified from Abbas, Lichtman & Pillai, Table 19-1 Type I hypersensitivity response IgE VH V L Cε1 CL Binds to mast cell Normal serum level = 0.0003 mg/ml Binds Fc region of IgE Link Intracellular signal trans. Initiation of degranulation Larche et al. Nat. Rev. Immunol 6:761-771, 2006 Abbas, Lichtman & Pillai,19-8 Factors in the development of allergic diseases • Geographical distribution • Environmental factors - climate, air pollution, socioeconomic status • Genetic risk factors • “Hygiene hypothesis” – Older siblings, day care – Exposure to certain foods, farm animals – Exposure to antibiotics during infancy • Cytokine milieu Adapted from Bach, JF. N Engl J Med 347:911, 2002. Upham & Holt. Curr Opin Allergy Clin Immunol 5:167, 2005 Also: Papadopoulos and Kalobatsou. Curr Op Allergy Clin Immunol 7:91-95, 2007 IgE-mediated diseases in humans • Systemic (anaphylactic shock) •Asthma – Classification by immunopathological phenotype can be used to determine management strategies • Hay fever (allergic rhinitis) • Allergic conjunctivitis • Skin reactions • Food allergies Diseases in Humans (I) • Systemic anaphylaxis - potentially fatal - due to food ingestion (eggs, shellfish, -
Food Allergy and Intolerance: a Narrative Review on Nutritional Concerns
nutrients Review Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns Domenico Gargano 1,†, Ramapraba Appanna 2,†, Antonella Santonicola 2 , Fabio De Bartolomeis 1, Cristiana Stellato 2, Antonella Cianferoni 3, Vincenzo Casolaro 2 and Paola Iovino 2,* 1 Allergy and Clinical Immunology Unit, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; [email protected] (D.G.); [email protected] (F.D.B.) 2 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; [email protected] (R.A.); [email protected] (A.S.); [email protected] (C.S.); [email protected] (V.C.) 3 Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA; [email protected] * Correspondence: [email protected]; Tel.: +39-335-7822672 † These authors contributed equally to this work. Abstract: Adverse food reactions include immune-mediated food allergies and non-immune-mediated intolerances. However, this distinction and the involvement of different pathogenetic mechanisms are often confused. Furthermore, there is a discrepancy between the perceived vs. actual prevalence of immune-mediated food allergies and non-immune reactions to food that are extremely common. The risk of an inappropriate approach to their correct identification can lead to inappropriate diets with severe nutritional deficiencies. This narrative review provides an outline of the pathophysiologic and clinical features of immune and non-immune adverse reactions to food—along with general Citation: Gargano, D.; Appanna, R.; diagnostic and therapeutic strategies. Special emphasis is placed on specific nutritional concerns for Santonicola, A.; De Bartolomeis, F.; each of these conditions from the combined point of view of gastroenterology and immunology, in Stellato, C.; Cianferoni, A.; Casolaro, an attempt to offer a useful tool to practicing physicians in discriminating these diverging disease V.; Iovino, P. -
What You Need to Know About the New Guidelines for the Diagnosis and Management of Food Allergy in the U.S
Allergy guidelines insert_Layout 1 9/26/11 1:36 PM Page 1 What you need to know about the new guidelines for the diagnosis and management of food allergy in the U.S. V OLUME 126, N O . 6 D ECEMBER 2010 • Tests for food-specific IgE are recom- Overview www.jacionline.org • The Guidelines, sponsored by the NIH Supplement to mended to assist in diagnosis, but should (NIAID), are based upon expert opinion THE JOURNAL OF not be relied upon as a sole means to di- Allergy ANDClinical and a comprehensive literature review. Immunology agnose food allergy. The medical history/ AAP had input on the document.1,2 exam are recommended to aid in diag- nosis. A medically monitored feeding Guidelines for the Diagnosis and Management Definitions of Food Allergy in the United States: Report of the (food challenge) is considered the most NIAID-Sponsored Expert Panel • Food allergy was defined as an adverse definitive test for food allergy. health effect arising from a specific im- • Food-specific IgE testing has numerous mune response. limitations; positive tests are not intrin- • Food allergies result in IgE-mediated sically diagnostic and reactions some- immediate reactions (e.g., anaphylaxis) OFFICIAL JOURNAL OF times occur with negative tests. These and several chronic diseases (e.g., ente- Supported by the Food Allergy Initiative issues are also reviewed in an AAP Clini - rocolitis syndromes, eosinophilic esopha - cal Report.3 Testing “food panels” with- gitis, etc), in which IgE may not play an important role. out considering history is often mis - leading. Tests selected to evaluate food allergy should be Epidemiology and Natural History based on the patient’s medical history and not comprise • Food allergy is more common in children than adults, large general panels of food allergens. -
Gluten Intolerance
2/10/2016 Some Questions We Will Explore • What is with the gluten‐free fad? • Are people who complain of gluten intolerance or gluten sensitivity— Gluten Intolerance: without having celiac disease—hypochondriacs or attention‐seekers? • Do some people who do not have celiac disease react negatively to Madness, Myth, Medicine or Mystery? ingested gluten? • Is gluten‐free just another passing fad upon which the food industry is Lunch and Learn capitalizing? Em M. Pijl‐Zieber PhD, RN Faculty of Health Sciences University of Lethbridge When Did All This Craze Start? What Is Gluten? • Gluten is found in grains such as wheat, barley, rye, and a cross between wheat and rye called triticale • Gluten is a complex protein formed of two protein structures: gliadin and glutenin, connected by disulfide bridge • Gluten is the magical protein responsible for the capability for bread dough to rise and contain carbon dioxide What Is Gluten? What Is This Gluten‐Free “Fad”? • According to Agriculture and Agri‐Food Canada (2013): • "Gluten free" is the fastest growing food intolerance category • Celiac disease is recognized as one of the most common chronic diseases world‐wide (Health Canada 2008), affecting an estimated 1% (1/133) of Canadians, with less than 10% of people with celiac disease having been diagnosed. 1 2/10/2016 What Is This Gluten‐Free “Fad”? What Is This Gluten‐Free “Fad”? • According to Agriculture and Agri‐Food Canada (2013): • According to Agriculture and Agri‐Food Canada (2013): • Almost one third of Canadians (10 million) are looking -
What Is the Difference Between Allergy, Sensitivity & Intolerance?
What Is the Difference Between Allergy, Sensitivity & Intolerance? The primary difference between an allergy, a sensitivity, and an intolerance is that an allergy is characterized by an immune system reaction to a substance, a sensitivity involves no immune response and an intolerance is characterized by the body lacking a chemical or enzyme needed to digest certain food. All, however, can be quite serious, and a range of symptoms can be caused by allergies, sensitivities, and intolerances. For this reason, it is a good idea to see a doctor about symptoms which appear to be linked to exposure to certain substances, to figure out precisely what is going on. Allergy: Although the word "Allergy" is commonly used to describe any unpleasant reaction to a drug, food, insect sting or chemical, this can be misleading. The word should only really be used to describe a reaction produced when the body meets a normally harmless substance, which has been “remembered" from a previous exposure and subsequently produces the "IgE" antibody. In the case of an allergy, the immune system learns to attack a particular substance for an unknown reason. In order for an allergy to develop, someone must be exposed to the substance at least once before the allergy will manifest. A classic example of an allergy is a peanut allergy, in which the immune system regards peanuts as harmful, and goes into overdrive when someone consumes peanuts or is exposed to peanut products. Some common symptoms linked with allergies are dermatological symptoms like eczema and hives, respiratory problems, anaphylaxis, rhinitis, and shock. -
Allergy/Immunology
259754_text 2-14 2/14/11 2:35 PM Page 17 To facilitate physician referrals, call: (901) 287-7337 or (866) 870-5570 Allergy/Immunology Le Bonheur Children’s Hospital treats more children with allergy and immunology problems than any other diagnosis. At Le Bonheur, board-certified pediatric allergists/immunologists perform comprehensive labora- tory testing to diagnose the child’s condition. Services include treatment and testing for: • Asthma • Allergic rhinitis • Immune disorders • Severe reactions to food, insect stings or drugs • Skin allergies Major diagnostic procedures include: • Secretion cytology • Allergy skin tests • Pulmonary function studies • Penicillin skin testing • RAST testing • Circulating eosinophil count • Bronchial challenge • EIA tests • Serum immunoglobulin levels Camp Wezbegon Camp Wezbegon is a fun-filled, one-week camp designed specifically for children ages 9 - 13 who have asthma. The camp’s emphasis is on having fun while learning. Campers participate in a variety of outdoor activities including swimming, hiking and nature study. They also attend a daily class on asthma manage- ment. Volunteer physicians, nurses, respiratory therapists, pharmacists, nutritionists and child life volunteers provide 24-hour medical supervision. A committee selects the campers, and services are provided free of charge. The camp is made possible through generous funding from donors. .................................Mary Ellen Conley, MD .................................Betty Lew, MD UT Le Bonheur Pediatric Specialists UT Le Bonheur -
Food Allergens in the Bakery
Food Allergens in the Bakery Major food allergens are: fish, peanuts, wheat, soy, tree nuts (such as almonds, filberts/hazelnuts, pecans, pistachios, walnuts), eggs, milk/dairy, and shellfish (such as shrimp, crab, or lobster). A food allergen can cause illness or death in some of your customers. Other sensitive ingredients include lactose, gluten, and sesame. Be aware of bakery products that contain allergens. The list below is not a full listing of potential allergens, but a list of more common ones found in bakery products: CMYK Milk/ • Butter • Sour Cream Lactose • Cream • Whipped Cream • Ice Cream • Yogurt • Milk • Cheese • Whey • Buttermilk • Caramel color or flavor Eggs • Egg washes—used on breads, sweet goods, • Egg substitutes made pastries, and pies with egg whites • Edible cake decorations Wheat/ • Wheat: • Barley Gluten • triticale • flour • Oats • graham • hydrolyzed wheat • Rye • kamut protein • Wheat derivatives: • semolina • matzoh • bran • grass • spelt • sprouted wheat • durum • malt • faro • wheat germ oil • germ • sprouts • einkorn • whole wheat berries • gluten • starch Peanuts/ • Artificial nuts • Almonds Tree Nuts • May be made from peanuts with tree nut • Filberts/Hazelnuts flavoring added • Peanuts • Marzipan • Pecans • Made from almond paste; used in cookies, • Pistachios sweet goods, and cakes • Walnuts • Pesto • May contain pine nuts or walnuts; added to some focaccia and savory breads Soy • Lecithin • Soy flour • Guar gum • Soy milk How Can I Help My Customers? • Some customers will ask you for ingredient information to make informed decisions. • Know where to find labels or product ingredient information to give them. • DO NOT use this information to make health recommendations. Let customers decide. For more in-depth information on the top 8 food allergens, see FARE’s Tips for Avoiding Your Allergen at foodallergy.org. -
Celiac Disease and Gluten Intolerance
Expert Updates in Celiac Disease and Gluten Intolerance Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Division of Gastroenterology University of California, San Diego Definitions and Terminology • Celiac disease (CD): a chronic small intestinal immune- mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals • Other terms including celiac sprue, sprue, gluten intolerance and gluten-sensitive enteropathy are no longer recommended • Gluten sensitivity = gluten intolerance ~ NCGS • Gluten is a protein in many grains wheat, rye, triticale • Wheat starch is the other key component of wheat Ludvigsson, J et al, Gut, 62(1):43-52;2013 Impact of Gluten-Free Eating • The gluten-free (GF) market is expected to reach $15 billion in annual sales by 20161 • Portion of households reporting purchases of GF increased from 5% in 2010 to 11% in 20131 • Common brands now available as GF • Increase in labeling of foods as GF that are naturally GF from vodka, water, to meats and poultry • The Onion reported in April 2014 “14% of Americans now intolerant to word “gluten” 1. New York Times articles, Feb 17, 2014, Oct 6, 2014 Forms of Gluten Sensitivity? Oslo Definitions Gluten Sensitivity Due to A chronic small intestinal Celiac Disease (CD) immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals Non-Celiac Gluten Sensitivity One or more immunological, (NCGS) morphological and/or symptomatic alterations triggered by gluten ingestion in individuals in whom celiac disease has been excluded Ludvigsson, J et al, Gut, 62(1):43-52; 2013 A Gluten-Sensitive Patient • A 28 yr old woman comes to see me for food intolerances and gluten sensitivity.