Food Sensitivities,
Allergic Reactions,and
Food Intolerances
食品敏感性、过敏性反应
和食品不耐性
CONTENTS 主要内容
? DEFINITION AND MECHANISMS OF
ADVERSE FOOD REACTION
第一节 食品不良反应的定义和机理
? SYMPTOMS OF ADVERSE FOOD
REACTIONS
第二节 食品不良反应的症状
?DIAGNOSIS OF ADVERSE FOOD REACTIONS
第三节 食品不良反应的诊断法
?PREVALENCE
第四节 发病率
?FOOD ALLERGENS
第五节 食品过敏原
?FOOD ADDITIVES
第六节 食品添加剂
?FOOD LABELING IN RELATION TO
FOOD SENSITIVITIES
第七节 与食品过敏性有关的食品标签
DEFINITION AND
MECHANISMS OF ADVERSE
FOOD REACTION
第一节 食品不良反应的定义和
机理
Fig.1 Classification of foods proposed by EAACI
图 1 EAACI对食品的分级
toxic food reactions 食品毒性反应
? A classical toxic food reaction is scombroid
fish poisoning,due to large amounts of
histamine
鲭亚目鱼组胺中毒是典型的食品毒性反应。
Food intolerance 食品不耐性
? enzymatic (resulting from an enzymatic defect,
e.g.,lactase deficiency),
,酶促性的”（因酶缺陷造成，如乳糖酶缺乏
症）
? pharmacological (depending on the direct effect
of,e.g.,vaso-active amines naturally found in
foods)
“药理学的”（取决于直接效应，如食品中天然
存在的血管活性胺）
?, Undefined不明确的”
SYMPTOMS OF ADVERSE
FOOD REACTIONS
第二节 食品不良反应的症状
IgE-Mediated Food Allergy
一、以 IgE-为媒介的食品敏感症
Characteristic 特征
Clinical manifestations of IgE-mediated food allergy can
remain localized at the site of the primary direct
contact,i.e.,一直保持在最初的直接接触部位
the mouth 嘴
throat (oral allergy syndrome)咽喉（口腔敏感综合症）
the gastroiniesrinal tract (isolated gastrointestinal food
allergy)胃肠道（单独的胃肠道食品敏感症）
Skin Respiratory tract GI tract Cardievascular S.
皮肤 呼吸道 胃肠道 心脏血管系统
45% 25% 20% 10%
Figure 2 Classical symptoms of IgE-mediated food ailergy
图 2 以 IgE为媒介的食品敏感综合症分布
Oral Allergy Syndrome
（一）口腔敏感综合病症
?Allergen,fresh foods( fruits and vegetables)
过敏原,新鲜食品 （ 如水果和蔬菜 ）
?Symptom 症状：
Itching of the lips,mouth,palate,throat
嘴唇, 嘴, 上腭咽喉等处立即发痒
Hoarseness and/or swelling of the lips,tongue,
uvula,and larynx
嗓音嘶哑, 嘴唇, 舌头, 小舌, 喉等肿胀
Allergic Reactions After
Ingestion of Food
（二）摄入食品后的过敏反应
? Symptom 症状：
1） The main symptoms of gastrointestinal food
allergy are vomiting,nausea,diarrhea,and
abdominal pains (colics or cramps).
胃肠道主要症状,呕吐、反胃、腹泻以及腹部疼痛
（绞痛或痛性痉挛）；
2) Skin reactions include local or
generalized pruritus,flush,
urticaria,angioedema,morbilliform
exanthema,and flare-up of atopic
dermatitis
皮肤反应：局部的或无显著特点的搔痒
症、面部潮红、风疹、血管性水肿、麻
疹样疹病、突发特异性皮炎；
3) The symptoms of the upper and the
lower respiratory tract are rhinitis
(sneezing,pruritus of the nose,
nasal stuffiness,and nasal
obstruction),larynx edema,cough,
wheezing,and bronchial asthma.
上呼吸道或稍低些的呼吸道症状：
鼻炎（打喷嚏、鼻搔痒症、鼻子不通气、
鼻塞）、喉肿、咳嗽、喘息以及支气管哮
喘；
4) Itching,redness,and watering
eyes (conjunctivitis)
发痒、充血以及眼睛流泪（结膜炎）,
Allergic Reactions After
Inhalation of Food
（三）吸入食品后的过敏反应
?Symptom 症状：
respiratory symptoms 呼吸道综合症
?Allergen,flour,n-amylase,green coffee,
castor and soy beans,spices,egg white,and
crustaceans
过敏原,面粉, α -淀粉酶, 绿咖啡, 海
狸香和大豆, 调味品, 鸡蛋白以及甲壳
动物
Allergic Reactions Following Skin
Contact With Food
（四）皮肤接触食品后的过敏反应
?Allergen,fish,shrimp,flour,and pork
过敏原,鱼, 小虾, 面粉和猪肉
?Symptom 症状：
Urticarial lesion 风疹
?Chronic contact with a food may induce
protein contact,dermatitis in food
handlers
食品操作工人长期接触某种食品会诱导蛋白接
触性皮炎 。
Non-lgE-Mediated Immune
Reactions
二、不以 IgE为媒介的免疫反应
Heiner's Syndrome,Allergic Alveolitis,and
Hemorrhagic Gastroenteritis in Childhood
（一）儿童 Heiner综合症、过敏性齿槽炎、
出血性肠胃炎
DEFINITION,The term Heiner's syndrome
characterizes a milk-induced syndrome
with pulmonary disease in infants,
Heiner综合症：婴儿因牛奶诱导的肺病
? Symptom 症状：
chronic or recurrent pulmonary intiltrates 慢性或
周期性发生的肺渗透
allergic alveolitis 过敏性齿槽炎
a chronic rhinitis 慢性鼻炎
gastrointestinal blood loss 肠胃失血症
iron deficiency anemia 缺铁性贫血
chronic cough 慢性咳嗽
recurrent fever 周期性发烧
Anorexia 厌食
Vomiting 呕吐
Colic 绞痛
Diarrhea 腹泻
Hemoptysis 咳血
?Control 控制措施：
? institution of a milk-free diet
饮食中去除牛奶
Gluten-Sensitive Enteropathy
(Celiac Disease)
（二）谷蛋白敏感性肠病（乳糜泻）
?Definition,damage to the small
intestinal mucosa and symptoms of
malabsorption
定义,小肠黏膜损伤和吸收不良症状小肠
黏膜损伤和吸收不良症状
?Allergen 过敏原：
Gliadin 麦醇溶蛋白
present in wheat,rye,barley,and oat
广泛存在于小麦、燕麦、大麦和黑麦中
The peak incidence of symptoms is in
infancy after the introduction of
cereals;
婴儿开始添加谷物类食物时最容易发生这类
症状, 为第一高峰期；
A second peak occurs during the third
decade.
第二高峰期发生在三十岁。
?Symptom 症状：
?abdominal pain周期性腹部疼痛
?loose stools便溏
?anorexia厌食
?short stature体态短小
?delayed puberty青春期滞缓
?nutritional deficiencies吸收不良
?Dental enamel hypoplasia 牙科瓷发育不全
?recurrent aphthae周期性口疮
?Control 控制措施：
Patients with celiac disease must
avoid gliadins and related proteins
permanently
远离麦醇溶蛋白以及相关蛋白质
Dermatitis Herpetiformis
（三）疱疹样皮炎
? Definition 定义：
chronic blistering disease
一种慢性起疱疾病
? Symptom 症状：
? itchy 发痒
? sometimes burning 有时有灼伤感
? eruption of grouped vesicles on an
erythematous ground 在红斑状范围内出现
成群泡样出疹
? Some DH patients,even without
gastrointestinal symptoms,may have villous
atrophy similar to that seen in celiac disease
有些 DH病人甚至在没有出现胃肠道综合症的
情况下, 也会出现与乳糜泻类似的绒毛状
萎缩症, 也就是说 DH与 CD之间有关连 。
? The cutaneous manifestations may or may not
respond to a gluten-free diet
饮食中排除麦醇溶蛋白可能会, 也有可能不
会改善皮肤症状 。
Eosinophilic Gastroenteritis
（四）嗜酸性胃肠炎
?Definition 定义：
elevated eosinophil counts in blood and
tissue eosinophilia with release of
eosinophii major basic protein
释放嗜曙红细胞主要基本蛋白质后，血液中嗜曙
红细胞和嗜曙红血球增多的间质组织内嗜曙红
细胞计数值升高
? Clinical manifestations 临床症状：
? vomiting 呕吐
? abdominal pain 腹部疼痛
? Diarrhea 腹泻
? malabsorption 吸收不良
? bowel obstruction 肠阻塞
? Ascites 腹水
? The cause of EG is unknown
起因还不清楚
? food hypersensitivity has been suggested
EG可能由食品超敏性引起
Utcerative Colitis
（五）溃疡性结肠炎
?Definition 定义：
an inflammatory bowel disease of
unknown origin
一种不明起因的炎症性肠病
? No adverse food reactions have been shown
as causative of UC
还不能证明食品不良反应会造成 UC
Allergic Vasculitis
（六） 变应性脉管炎
?Cause 起因：
foods and food additives
食品及其添加剂
?Symptom 症状：
allergic purpura (widespread hemorrhagic
macules and papules,mainly on the
lower legs) demonstrated by single
challenges
变应性紫癜（分布广泛的出血性斑丘疹，主要
出现在腿的下部）
Food Intolerance
三,食品不耐性
Lactase Deficiency
乳糖酶缺乏综合征
?Definition 定义：
Lack of the enzyme that cleaves milk sugar,
lactose,gives rise to adverse reactions
when lactose is consumed.
当摄入乳糖时，由于体内缺乏一种能将牛奶糖质 -
---乳糖水解的酶，从而产生不良反应
?The only food of which lactose is a
natural constituent is milk (3.7
g/100 ml cows milk).
天然含乳糖的唯一食品是牛奶 （ 3.7g/ml
牛奶 ）
?Classification 分类：
1） congenital lactase deficiency先天性乳糖酶
缺乏综合征
2） primary lactase deficiency初级的乳糖酶
缺乏综合征
3） secondary lactase deficiency二级乳糖酶
缺乏综合征
1） congenital lactase deficiency先天性乳糖酶
缺乏综合征
lactase is not present and symptoms will appear
when the patient is breast-fed.
人体内不存在乳糖酶, 当进行人乳哺育时
会出现综合征
The congenital form is very rare
这种症状极少见
2） primary lactase deficiency初级的乳糖酶缺
乏综合征
seen in most of the world's population
where the production of lactase
decreases or disappears from the age of
2 to the teenage years
在 2-10岁时，乳糖酶分泌下降或消失
? Persistent high lactase activity in adult
life occurs among relatively few ethnic
groups:
成年人体内乳糖酶活性一直处于高峰的人群：
? northern Europeans and their overseas
descendants北欧以及沿海后代
? a few African groups of pastoral tradition
Bedouins and other Saudi Arabs一些源于牧人
的非洲人, 贝都因人和沙特阿拉伯人
? certain groups from west India and
Pakistan西印度和巴基斯坦部分人群
? 3） secondary lactase deficiency二级乳糖酶缺
乏综合征
a consequence of pathological changes in
the gut mucosa,as seen in celiac
disease or inflammations.
乳糜泻或炎症引起内脏黏膜病变的结果
When the gut mucosa has regained its
normal appearance the lactase production
reappears
当内脏黏膜恢复正常，乳糖酶也开始重新分泌。
?The symptoms 症状：
Diarrhea 腹泻
gas production 产气
Colic 绞痛
? Control 控制措施：
avoid all products containing even
small amounts of lactose
避免食用任何含乳糖的食品
PREVALENCE
第四节 发病率
? The total prevalence of food allergy/food intolerance is not
known.
总发病率未知
? Estimates based on data from one country do not necessarily
reflect the prevalence of another country
在某个国家统计得到的数据并不能用到另一个国家, 因
为：
1） frequency and duration of breast feeding
母乳喂养的频率和持续时间
2） eating habits饮食习惯
3） flora植物群
Children
一、儿童
Food
（一）食品
? allergy to cow's milk,egg,and fish
predominantly begins before the second year
of age
对牛奶, 鸡蛋和鱼的过敏性主要发生 2岁以前
? allergy to fruit,legumes,and vegetables
predominantly begins after the second year.
对水果、豆类和蔬菜的过敏性主要发生在 2岁以后
? Table 1 Prevalence of Rhinitis and Oral
Itch in Danish School Children
丹麦学龄儿童中鼻炎和口腔发痒的发病率
Age (yr) Rhinitis (%) Oral itch（ %)
boys/girls boys/girls
5-7 9.0/5.7 0/0.3
8-10 8.5/7.1 0.8/1.1
11-13 14.0/8-5 1.9/1.5
14-16 17.3/13.0 2.9/2.0
Food Additives
（二）食品添加剂
? Adverse reactions to food additives are found in
1-2% of school children
1-2%学龄儿童对食品添加剂有不良反应
? The prevalence in younger children is not known.
至今不知小年龄儿童的发病率
Adults
二、成年人
Food
（一）食品
? In European studies the majority of
allergic food reactions in adults are
caused by fruits,vegetables,and nuts and
are related to pollen allergy
在欧洲，大部分成年人食品过敏性反应是由水果、
蔬菜和坚果引起的，且与花粉过敏症有关
? The prevalence is around 5%
发病率在 5%左右
?probably only 0,5% have symptoms
other than oral itch.
大约只有 0.5%不是口腔发痒症状
?The prevalence of allergy to milk,
egg,fish,etc,is around 0.2%，，
牛奶、鸡蛋、鱼等引起的过敏症发病率
大约为 0.2%
Food Additives
（二）食品添加剂
?The estimated frequency was 0.03-0.15%
1982年 EEC理论计算值：食品添加剂引起的
发病率为 0.03-0.15%
?In British, the prevalence
大不列颠人, 发病率为 0.026%
?Dutch 丹麦, 0.4%
Contact Allergens
（三）接触性过敏原
? 10 % Danish women have contact allergy
caused by nickel,
10%丹麦 妇女因镍造成接触性过敏症
? Up to 10% of these may benefit from a
nickel-restricted diet
其中 10%以上会因排除镍的饮食而改善
?What is contact allergens？
In dermally sensitized subjects
ingestion of the contact allergen may
cause skin flare reactions or other
symptoms,e.g.,in the
gastroinlestinal tract
皮肤敏感症受检者摄入接触性过敏原后会
导致皮肤潮间带反应或胃肠道症状等其他
症状。
?Contact Allergens：
fragrances 芳香物质
food flavors（ natural or synthetic） 食品风味物
Nickel 镍
Other Adverse Reactions
（四）其它不良反应
1） Celiac disease腹部疾病：
Cause,wheat gliadin and related proteins
起因：小麦麦醇溶蛋白和相关蛋白质
The prevalence, 0.2-0.5%
发病率,0.2-0.5%
2） lactase deficiency 乳糖酶缺乏综合征
Cause,Lack of lactase
起因：缺乏乳糖酶
The prevalence, varies from a few
percent in northern European countries
to almost the entire adult population in
Asia and Africa
发病率,从北欧国家到亚洲和非洲国家，
成年人发病率相差好几个百分点
Conclusion：
It is not known whether the prevalence
of food allergy or intolerance is
increasing
不清楚食品过敏 /不耐性的发病率是否有上
升趋势
The prevalence of pollen-related food allergies
has increased.
与花粉相关食品敏感症的发病率在提高 。
FOOD ALLERGENS
第五节 食品过敏原
Definition 定义
? Allergens are antigens that give rise to
allergy,
过敏原是能引起敏感的抗原
Where is food allergens from？
? Pollen花粉
? Mammals哺乳动物
? mites螨
? other insects其他昆虫
? foods食品
?Component：过敏原成分：
Proteins or glycoproteins with a molecular weight
from 3 to 90 kDa,the majority ranging from 10
to 40 kDa
已知结构的过敏原都是蛋白质或糖蛋白，分
子量从 3kDa到 90kDa，大部分在 10kDa到
40kDa之间
The identified allergens：
? the first three letters of the genus,space,the first
letter of the species,space,and an Arabic number,
? XXX X X
属 种 阿拉伯数字
? For example,Lol p 1 refers to the first pollen
allergen identified from Lolium perennc,or rye
grass
Lol p 1表示第一个花粉过敏原，来自 Lolium
perenne 或黑麦草
Classification 分类
"major",proteins for which 50% or more of the
allergic patients studied have specific IgE
“主要的,,能使 50%或以上被研究病人具有特异性 IgE
的蛋白质
"minor“,the remaining allergens are considered
minor
“次要的,,能使 50%以下的被研究病人具有特异性 IgE
的蛋白质
The Nature of Food Allergens
一、过敏原的种类
?To make a complete list of allergenic
foods on a global basis is virtually
impossible.
我们不可能列出一张食品过敏原清单
?Whether a food allergen causes
significant problems in a population
is dependent on several factors：
某种食品过敏原是否会在消费者中引起明显
的问题取决于以下几个方面：
（ a） the potency of the allergen
过敏原的效能
? some are much more frequent sensitizers lhan
others
有些抗体比其他抗体造成敏感症的次数更多,
e.g.,β -lactoglobulin in milk or ovomucoid from
egg white
如：牛奶中的 β-乳球蛋白或鸡蛋蛋白中的卵
类粘蛋白
（ b） the physiochemical properties
物化性质：
1） The chemical structure,i.e.,the amino acid sequence,
and the tertiary structure
化学结构如氨基酸序列, 蛋白质三级结构
2） heat stability 热稳定性
3） digestibility 可消化性
4） Structural relationship with epitopes from nonfood
allergens
非食品过敏原与抗原决定族之间的结构关系
（ c） the frequency of exposure
暴露的频率：
? In Europe allergy to rice and buckwheat is
uncommon.
在欧洲, 稻米和荞麦一般不引起敏感症
? In Japan rice and buckwheat are common
food allergens
在日本, 稻米和荞麦通常是食品过敏原 。
(d) the route of exposure
暴露途径
1 ） aero-allergens,grasses,pollen of trees and
herbs, house dust mites, o cat dander
飞散过敏原,草, 树或药草的花粉, 屋尘螨, 猫
毛发皮屑
2） work environment,baker
工作环境：面包工人
3） via the skin,Natural rubber (latex)
通过皮肤：天然橡胶
（ e） cross-reactions to aero-allergens
飞散过敏原的交叉反应
1) local species of grass,trees,and herbs and pollution
当地生长的草, 树以及药草种类
e.g.,Allergy to hazelnuts is common in areas with many
birch trees,where birch pollen hay lever is frequent
榛实敏感症一般发生在有许多桦树的地区, 在这些地
区经常发生桦树花粉热
2) air pollution空气污染
(f) the age at which the allergen is introduced
受过敏原入侵的个体年龄
? In early infancy an increased uptake of
antigen takes place at a time when the gut-
associated lymphoid tissue is still
incompletely developed
在幼年早期, 在与消化道相关淋巴组织还
没有发育好的时候, 抗原的摄入量相对
较高 。
Allergens of Animal Origin
二、来源于动物的过敏原
Milk （一）牛奶
1） Albumin,β -lactoglobulin,and immunoglobulins of
milk are the most important allergens in infants
婴儿：清蛋白,β-乳球蛋白和免疫球蛋白
2） In older children β -lactoglobulin,caseins,and I-
lactalbumin may be more reactive.
大孩子,β-乳球蛋白、酪蛋白和 ?-乳白蛋白
3） in adulthood,casein to be the most frequent allergen
成人期：酪蛋白
cross-reactions交叉反应
? The majority of patients with allergy to
cow's milk proteins will also react to
proteins from sheep's and goat's milk
大部分对牛奶蛋白质有敏感症的病人同样
对绵羊奶和山羊奶有敏感症
Cross-reactions between milk from these
species is not always present.
各种奶之间的交叉反应并不一直存在
Eggs
（二）鸡蛋
? the second most frequent food allergen in
small children after cow's milk
在小孩子中大概是仅次于牛奶的食品过敏原
? Egg white proteins are reported to elicit
allergic reactions more frequently than
egg yolk.
鸡蛋蛋白比蛋黄更易引起过敏反应
蛋黄中的主要过敏原
Protein
蛋白质
Name
分类名
molecular
weight
分子量 (kDa)
Content in egg white
鸡蛋白中的含量 (%)
Ovomucoid (*key)
卵类粘蛋白
Gal d 1 28000 11
Ovalbumin
卵清蛋白
Gal d 2 45000 54
Ovotransferrin
or conalbumin
卵铁传递蛋白或伴
清蛋白
Gal d 3 78000 12
Lysozyme
溶菌酶
Gal d 4 14000 3.4
? cross-reactions交叉反应,
? allergy to egg can be correlated to
allergy to bird feathers
鸡蛋敏感症与鸟类羽毛敏感症之间有相关性
? the major cross-reacting determinants
are the livetins from egg yolk.
主要交叉反应的决定因素是蛋黄中的卵黄蛋白
Allergens of Plant Origin
三、来源于植物的过敏原
The vegetable foods that most commonly
cause hypersensitivity symptoms
致敏性蔬菜种类
? hazelnut 榛实
? Walnut 胡桃
? Brazil nut 巴西坚果
? Apple 苹果
? Almond 杏仁
? Peach 桃子
? Plum 李子
? Cherry 樱桃
?Peanut 花生
?Peas 豌豆
?Carrot 胡萝卜
?parsley 欧芹
?Celery 芹菜
?Orange 橘子
?Strawberry 草莓
?Cereals 谷物
The ranking lists vary depending on
各种蔬菜致敏程度的影响因素
1） the age of the patients
病人的年龄
2） the methods of diagnosis
诊断方法以及
3 ） the geographic location of the
population
地理环境
Fruits,Nuts,and Vegetables
（一）水果、坚果和蔬菜
? More than 90% of patients with sensitization to
vegetable foods had concomitant sensitization to
pollen 90%
以上 的蔬菜敏感症总是伴随着花粉敏感症而来
? In a group of birch pollen allergies the patients with
additional hypersensitivity to nuts and apples had：
? 在一组同时有另外的坚果和苹果超敏性的桦树花
粉敏感症病人中
? (1) more severe symptoms during the pollen season
? 在花粉季节症状严重加重
? (2) higher values of IgE to birch and hazel pollen,
? 桦树和榛子花粉的 IgE值较高
? (3) a larger area of the skin prick test reactive to birch
and hazel pollen compared to the group without apple
and nut allergy
? 与那些没有坚果和苹果超敏性病人相比, 桦树和
榛子花粉的皮肤穿刺试验反应区域要大得多 。
?The symptoms 主要症状：
?Mainly from the mouth and pharynx,
with itching,swelling of the lips,
tongue,and throat,syndrome.
从嘴到咽发痒，嘴唇、舌头以及咽喉肿胀
?These symptoms are called the,oral
allergy”
“口腔敏感综合症,
?cross-reactions交叉反应,
1） A sensitization to mugwort pollens
and different spices,the so-called
mugwort-celery-spices syndrome,has
been reported
艾蒿及其不同种艾属植物的花粉有致敏
性，又称艾蒿 -芹菜 --香料综合症。
2） It was shown by prick,RAST studies,and RAST
inhibition experiments
皮肤穿刺,RSAT研究以及 RSAT抑制实验证明：
a celery-thermolabile allergen seems to be involved in
celery-birch-pollen-allergic patients
一种不耐热芹菜过敏原会导致芹菜 -桦树 -花粉敏感症
a thermostable allergen is involved in celery -mug wort-
allergic patients,
一种耐热过敏原会导致芹菜 -艾蒿敏感症
?Pollen-related food allergies are
thought to be caused by cross-
reactions of pollen-specific IgE
antibodies with epitopes of food
proteins.
花粉特异 IgE抗体与食品蛋白质的抗原决定
族发生交叉反应，导致了花粉相关食品
敏感症
Three distinct cross-reactive structures in
pollen and vegetable foods
花粉和蔬菜中的 3个明显交叉反应结构
1） Bet v l is the major birch pollen allergen
Bet v 1是主要的桦树花粉过敏原
? Allergens with cross-reactivity to Bet v 1,
与 Bet v 1有交叉反应的过敏原有：
? Apples 苹果
? Hazelnuts 榛实
? cherries 樱桃
?Pears 梨子
?Celery 艾蒿
?carrots 胡萝卜
2 ） Profilins are widely distributed in the plant
kingdom and have been identified as "plant pan
Allergens."
? Profilin广泛分布在植物王国, 被称为, 植物 pan
过敏原,
? 10 to 20% of the pollen-allergic patients are
sensitized to pronlins.
? 10-20%花粉敏感病人对 profilins敏感
? 3） Cross-reactions of allergen-specific IgE
antibodies can be caused by so-called
"cross-reactive carbohydrate determinants"
of food and pollen glycoproteins.
? 食品和花粉糖蛋白, 又称为, 交叉反
应碳水化合物决定物, 会引起 过敏原与
特异性 IgE抗体的交叉反应 。
Cereals
（二）谷物
?two major allergens,
两个主要过敏原 IgE：
one at 47 kDa
one at 20 kDa
?When challenged with double-blind,
placebo-controlled food challenge
DBPCFC实验证实
21% of the patients with suspected
allergy to cereals had symptoms
21%谷物过敏儿童有综合症状
8% had clinical reactions to only one
cereal
8%儿童只对一种谷物有临床反应
The majority of the children had
clinical reactions to wheat (76%)
大部分儿童（ 76%）对谷物有临床反应
Legumes （三）豆类
?Peanut allergy may be the most common
food allergy in the United States
在美国，花生敏感症是最常见的食品敏感症
Allergic reactions are often acute and
severe
过敏反应经常是急性和严重的
?The major peanut allergen：
主要的花生过敏原：
?
glycoprotein
糖蛋白
Ara h 1,molecular weight of 66 kDa
Ara h 2,molecular weight of 17 kDa
{
?The characteristic特征：
?heat stable 热稳定性
?a potential source of "hidden food
allergens
一种, 隐藏性食品过敏原, 的潜在资源
Natural Rubber (Latex)-Related Food Allergens
（四）与天然橡胶（乳胶）有关食品过敏原
? The latex allergens are proteins from the
rubber tree
乳汁过敏原是来自橡胶树的蛋白质
? Common antigenic determinants demonstrated
between latex and avocado,chestnut,and banana
乳汁与鳄梨, 栗子和香蕉之间存在共同的抗原定子
?Allergy to natural rubber (latex)
has become increasingly problematic
天然橡胶（乳汁）敏感症有上升趋势
?These reactions are severe,e.g.,
anaphylactic shock
许多反应是严重的，如过敏性休克
FOOD ADDITIVES
第六节 食品添加剂
?Chemically and functionally food
additives are a very heterogeneous
group of substances consisting of：
化学性的和功能性的食品添加剂的组成：
Enzymes 酶
Flavors 风味物
Colors 色素
Preservatives 防腐剂
Emulsifiers 乳化剂
Antioxidants 抗氧化剂
Sweeteners 甜味剂
Colors
一、色素
Azo Colors
（一） 含氮色素
? The azo colors cause adverse reactions,
会造成不良反应的含氮色素：
tartrazine酒石黄
sunset yellow落日黄
azorubin/carmoisin偶氮玉红
amaranth苋菜红
ponceau 4R丽春红 4R
Symptoms,
mainly on the skin and mainly urticaria
主要症状：皮肤风疹
? Tartrazine has been the additive of choice
when researchers have tried to elucidate the
mechanism of food-additive intolerance
酒石黄作为机理实验物
? a pharmacological effect of tartrazine and
other azo colors
酒石黄和其他含氮色素具有药物学影响
? pharmacological effect：
药物学影响：
? a large cumulative dose of tartrarine (200 mg) in
normal subjects resulted in a significant rise in plasma
and urinary histamine levels,
患者体内酒石黄积累到很高浓度时，血浆和尿液
中组胺浓度明显升高
? The histamine release was not accompanied by
systemic symptoms
全身组织综合症状导致组胺不能完全释放出来
Nonazo colors
（二） 无氮色素
? Nonazo colors could give adverse reactions,
会造成不良反应的无氮色素：
? Annatto 果红
? Indigo 靛蓝
? Carmine 胭脂红
? Erythrosine 赤藓红
? patent blue 专利蓝 (三苯甲烷系染料）
? Symptoms,
mainly on the skin and mainly urticaria
主要症状为皮肤风疹
Preservatives
二、防腐剂
Benzoic and Sorbic Acid
（一）安息香酸和山梨酸
causes of urticaria
造成接触性风疹
provoke itching and tingling in the mouth
出现口腔发痒和麻刺感
The mechanism is not known
其致病机制未知
Sulfites
（二） 亚硫酸盐
? symptoms 症状：
asthma 哮喘
anaphylactic reactions 皮肤过敏
symptoms on the skin 皮肤综合症
the likelihood of a reaction depend on：
致敏反应的可能性取决于,
? The nature of the food食品的特性
? the level of residual sulfite亚硫酸盐的残留水平
? the sensitivity of the patient病人的敏感性
? the form of residual sulfite亚硫酸盐的残留形式
? the mechanism of the sulfite-induced reaction
亚硫酸盐诱导反应机理
the cause of asthmatic reactions to
sulfltes in food
亚硫酸盐哮喘反应的原因：
?inhalation of sulfur dioxide
liberated during ingestion
食用时吸入了二氧化硫
?deficiency of sulfite oxidase
缺乏亚硫酸盐氧化酶
Metabisulfite 偏亚硫酸氢钠
? Metabisulfite-induced basophil histamine release in a
nonasthmatic patient
偏亚硫酸氢盐具有诱发嗜碱细胞释放组胺的功能
? developed urticaria and angi oedema following
provocation with sodium metabisulfite
偏亚硫酸氢钠激发会造成风疹和血管性水肿
an IgE-mediated reaction
偏亚硫酸氢钠的敏感性是一种以 IgE为媒介的反应
Flavor Enhancers and Flavors
三、风味促进剂和香精
Flavor Enhancers,Monosodium Glutamate
（一）风味促进剂：味精
?The result of monosodium glutamate
(MSG) was the Chinese restaurant
syndrome (CRS) and asthma。
味精会造成：
中国餐馆综合症（ CRS）
喘病症
1） symptoms of CRS 症状：
headache 头痛
a burning sensation along the back of the neck
沿着脖子背部的灼热感
chest tightness 胸闷
Nausea 作呕
Sweating 发汗
? Symptoms characteristic of the Chinese
restaurant syndrome can be provoked in a
limited number of individuals by high
concentrations of MSG,reaching a frequency
of about 30% at concentrations higher than 3
g/100 ml.
当味精浓度高于 3g/100ml时, 发病率为 30%
左右 。
? Where MSG is used in very high amounts.
Chinese restaurant syndrome can be provoked in
sensitive subjects.
当敏感受检者在食用了这类味精用量很高的食
品后, 会出现中国餐馆综合症
Wonton soup may contain up to 5 g of MSG per
bow
每碗馄饨 汤中含味精 5g
2） Asthma哮喘：
Whether MSG induces asthma is currently still
under debate.
目前对味精是否会诱导哮喘一说仍处于争论
之中 。
Flavors （二）香精
? Fragrance materials used in perfumes and other
cosmetic products can cause allergic contact
dermatitis.
香水和其他化妆品中的香味物质会引起敏感性接触皮
炎
? Many of the chemical substances in fragrances
are identical to chemicals found in food
flavors.
香味化学成分与食品香料化学物质在成分上是一致
? A number of the 30-40 chemicals in balsam
of Peru are identical or closely related to
chemicals present in spices and food
flavors (e.g.,vanillin,eugenol,cinnamic
aldehyde)
秘鲁香液与食品香料或风味物质（如香兰素、丁
子香酚、肉桂醛）有 30-40种相同的化学成分
? Balsam of Peru is used in the standard
patch test series in dermatology to test
for contact allergy to fragrance materials.
在皮肤病学的标准皮肤过敏试验中, 一般就用秘
鲁香液作为试验物进行试验 。
?Control 控制措施：
Forty-seven percent of the patients
placed on a balsam-restrictive diet
showed long-term improvement.
经香液排除饮食后,47%病人得到长期恢复。
?Difficulty 困难：
? Chemical flavor are found in all plants in
various amounts
大部分香精都能在植物中发现
? It was difficult to pinpoint one causative
chemical and to design an effective diet。
很难查明到底是哪种化学物质造成了过敏反应,
就难以有效设计饮食以避免过敏
Solvents,Propylene Glycol
四、溶剂：丙二醇
APPLICATION 应用
? a solvent of flavors 香精溶剂
food industry 食品工业
cosmetics 化妆品
Special application
?It gives cakes a nice soft texture
? 使蛋糕具有松软的组织结构
?The manufacturer to use it in
larger amounts than its function as
a solvent can justify..
制造商会因此超过其功能范围而大量使
用
?Symptoms 症状：
?Extensive exanthem (reddening of the
skin) within 3-16 h of ingestion
食用 3-16h后出现大范围皮疹（皮肤发红）
?Subsided without any medication in
24-48 h.
不进行治疗的话,24-48h后症状自行消退
Antioxidants
五、抗氧化剂
? BHA和 BHT：
flare-up contact allergy after
ingestion of BHA or BHT
爆发接触性敏感症
chronic urticaria
慢性风疹
Enzymes and Vegetable Gums
六、酶和植物胶
Characteristic,IgE-mediated allergic reactions
特点：以 IgE为媒介的过敏反应
Exposure pathway：
1） inhalation in the workplace
工作场所吸入
2） papain used as a meat tenderizer via the
respiratory route is also a possibility.
鸡肉肉质嫩化剂 ----木瓜蛋白酶通过呼吸道
THE END！
Allergic Reactions,and
Food Intolerances
食品敏感性、过敏性反应
和食品不耐性
CONTENTS 主要内容
? DEFINITION AND MECHANISMS OF
ADVERSE FOOD REACTION
第一节 食品不良反应的定义和机理
? SYMPTOMS OF ADVERSE FOOD
REACTIONS
第二节 食品不良反应的症状
?DIAGNOSIS OF ADVERSE FOOD REACTIONS
第三节 食品不良反应的诊断法
?PREVALENCE
第四节 发病率
?FOOD ALLERGENS
第五节 食品过敏原
?FOOD ADDITIVES
第六节 食品添加剂
?FOOD LABELING IN RELATION TO
FOOD SENSITIVITIES
第七节 与食品过敏性有关的食品标签
DEFINITION AND
MECHANISMS OF ADVERSE
FOOD REACTION
第一节 食品不良反应的定义和
机理
Fig.1 Classification of foods proposed by EAACI
图 1 EAACI对食品的分级
toxic food reactions 食品毒性反应
? A classical toxic food reaction is scombroid
fish poisoning,due to large amounts of
histamine
鲭亚目鱼组胺中毒是典型的食品毒性反应。
Food intolerance 食品不耐性
? enzymatic (resulting from an enzymatic defect,
e.g.,lactase deficiency),
,酶促性的”（因酶缺陷造成，如乳糖酶缺乏
症）
? pharmacological (depending on the direct effect
of,e.g.,vaso-active amines naturally found in
foods)
“药理学的”（取决于直接效应，如食品中天然
存在的血管活性胺）
?, Undefined不明确的”
SYMPTOMS OF ADVERSE
FOOD REACTIONS
第二节 食品不良反应的症状
IgE-Mediated Food Allergy
一、以 IgE-为媒介的食品敏感症
Characteristic 特征
Clinical manifestations of IgE-mediated food allergy can
remain localized at the site of the primary direct
contact,i.e.,一直保持在最初的直接接触部位
the mouth 嘴
throat (oral allergy syndrome)咽喉（口腔敏感综合症）
the gastroiniesrinal tract (isolated gastrointestinal food
allergy)胃肠道（单独的胃肠道食品敏感症）
Skin Respiratory tract GI tract Cardievascular S.
皮肤 呼吸道 胃肠道 心脏血管系统
45% 25% 20% 10%
Figure 2 Classical symptoms of IgE-mediated food ailergy
图 2 以 IgE为媒介的食品敏感综合症分布
Oral Allergy Syndrome
（一）口腔敏感综合病症
?Allergen,fresh foods( fruits and vegetables)
过敏原,新鲜食品 （ 如水果和蔬菜 ）
?Symptom 症状：
Itching of the lips,mouth,palate,throat
嘴唇, 嘴, 上腭咽喉等处立即发痒
Hoarseness and/or swelling of the lips,tongue,
uvula,and larynx
嗓音嘶哑, 嘴唇, 舌头, 小舌, 喉等肿胀
Allergic Reactions After
Ingestion of Food
（二）摄入食品后的过敏反应
? Symptom 症状：
1） The main symptoms of gastrointestinal food
allergy are vomiting,nausea,diarrhea,and
abdominal pains (colics or cramps).
胃肠道主要症状,呕吐、反胃、腹泻以及腹部疼痛
（绞痛或痛性痉挛）；
2) Skin reactions include local or
generalized pruritus,flush,
urticaria,angioedema,morbilliform
exanthema,and flare-up of atopic
dermatitis
皮肤反应：局部的或无显著特点的搔痒
症、面部潮红、风疹、血管性水肿、麻
疹样疹病、突发特异性皮炎；
3) The symptoms of the upper and the
lower respiratory tract are rhinitis
(sneezing,pruritus of the nose,
nasal stuffiness,and nasal
obstruction),larynx edema,cough,
wheezing,and bronchial asthma.
上呼吸道或稍低些的呼吸道症状：
鼻炎（打喷嚏、鼻搔痒症、鼻子不通气、
鼻塞）、喉肿、咳嗽、喘息以及支气管哮
喘；
4) Itching,redness,and watering
eyes (conjunctivitis)
发痒、充血以及眼睛流泪（结膜炎）,
Allergic Reactions After
Inhalation of Food
（三）吸入食品后的过敏反应
?Symptom 症状：
respiratory symptoms 呼吸道综合症
?Allergen,flour,n-amylase,green coffee,
castor and soy beans,spices,egg white,and
crustaceans
过敏原,面粉, α -淀粉酶, 绿咖啡, 海
狸香和大豆, 调味品, 鸡蛋白以及甲壳
动物
Allergic Reactions Following Skin
Contact With Food
（四）皮肤接触食品后的过敏反应
?Allergen,fish,shrimp,flour,and pork
过敏原,鱼, 小虾, 面粉和猪肉
?Symptom 症状：
Urticarial lesion 风疹
?Chronic contact with a food may induce
protein contact,dermatitis in food
handlers
食品操作工人长期接触某种食品会诱导蛋白接
触性皮炎 。
Non-lgE-Mediated Immune
Reactions
二、不以 IgE为媒介的免疫反应
Heiner's Syndrome,Allergic Alveolitis,and
Hemorrhagic Gastroenteritis in Childhood
（一）儿童 Heiner综合症、过敏性齿槽炎、
出血性肠胃炎
DEFINITION,The term Heiner's syndrome
characterizes a milk-induced syndrome
with pulmonary disease in infants,
Heiner综合症：婴儿因牛奶诱导的肺病
? Symptom 症状：
chronic or recurrent pulmonary intiltrates 慢性或
周期性发生的肺渗透
allergic alveolitis 过敏性齿槽炎
a chronic rhinitis 慢性鼻炎
gastrointestinal blood loss 肠胃失血症
iron deficiency anemia 缺铁性贫血
chronic cough 慢性咳嗽
recurrent fever 周期性发烧
Anorexia 厌食
Vomiting 呕吐
Colic 绞痛
Diarrhea 腹泻
Hemoptysis 咳血
?Control 控制措施：
? institution of a milk-free diet
饮食中去除牛奶
Gluten-Sensitive Enteropathy
(Celiac Disease)
（二）谷蛋白敏感性肠病（乳糜泻）
?Definition,damage to the small
intestinal mucosa and symptoms of
malabsorption
定义,小肠黏膜损伤和吸收不良症状小肠
黏膜损伤和吸收不良症状
?Allergen 过敏原：
Gliadin 麦醇溶蛋白
present in wheat,rye,barley,and oat
广泛存在于小麦、燕麦、大麦和黑麦中
The peak incidence of symptoms is in
infancy after the introduction of
cereals;
婴儿开始添加谷物类食物时最容易发生这类
症状, 为第一高峰期；
A second peak occurs during the third
decade.
第二高峰期发生在三十岁。
?Symptom 症状：
?abdominal pain周期性腹部疼痛
?loose stools便溏
?anorexia厌食
?short stature体态短小
?delayed puberty青春期滞缓
?nutritional deficiencies吸收不良
?Dental enamel hypoplasia 牙科瓷发育不全
?recurrent aphthae周期性口疮
?Control 控制措施：
Patients with celiac disease must
avoid gliadins and related proteins
permanently
远离麦醇溶蛋白以及相关蛋白质
Dermatitis Herpetiformis
（三）疱疹样皮炎
? Definition 定义：
chronic blistering disease
一种慢性起疱疾病
? Symptom 症状：
? itchy 发痒
? sometimes burning 有时有灼伤感
? eruption of grouped vesicles on an
erythematous ground 在红斑状范围内出现
成群泡样出疹
? Some DH patients,even without
gastrointestinal symptoms,may have villous
atrophy similar to that seen in celiac disease
有些 DH病人甚至在没有出现胃肠道综合症的
情况下, 也会出现与乳糜泻类似的绒毛状
萎缩症, 也就是说 DH与 CD之间有关连 。
? The cutaneous manifestations may or may not
respond to a gluten-free diet
饮食中排除麦醇溶蛋白可能会, 也有可能不
会改善皮肤症状 。
Eosinophilic Gastroenteritis
（四）嗜酸性胃肠炎
?Definition 定义：
elevated eosinophil counts in blood and
tissue eosinophilia with release of
eosinophii major basic protein
释放嗜曙红细胞主要基本蛋白质后，血液中嗜曙
红细胞和嗜曙红血球增多的间质组织内嗜曙红
细胞计数值升高
? Clinical manifestations 临床症状：
? vomiting 呕吐
? abdominal pain 腹部疼痛
? Diarrhea 腹泻
? malabsorption 吸收不良
? bowel obstruction 肠阻塞
? Ascites 腹水
? The cause of EG is unknown
起因还不清楚
? food hypersensitivity has been suggested
EG可能由食品超敏性引起
Utcerative Colitis
（五）溃疡性结肠炎
?Definition 定义：
an inflammatory bowel disease of
unknown origin
一种不明起因的炎症性肠病
? No adverse food reactions have been shown
as causative of UC
还不能证明食品不良反应会造成 UC
Allergic Vasculitis
（六） 变应性脉管炎
?Cause 起因：
foods and food additives
食品及其添加剂
?Symptom 症状：
allergic purpura (widespread hemorrhagic
macules and papules,mainly on the
lower legs) demonstrated by single
challenges
变应性紫癜（分布广泛的出血性斑丘疹，主要
出现在腿的下部）
Food Intolerance
三,食品不耐性
Lactase Deficiency
乳糖酶缺乏综合征
?Definition 定义：
Lack of the enzyme that cleaves milk sugar,
lactose,gives rise to adverse reactions
when lactose is consumed.
当摄入乳糖时，由于体内缺乏一种能将牛奶糖质 -
---乳糖水解的酶，从而产生不良反应
?The only food of which lactose is a
natural constituent is milk (3.7
g/100 ml cows milk).
天然含乳糖的唯一食品是牛奶 （ 3.7g/ml
牛奶 ）
?Classification 分类：
1） congenital lactase deficiency先天性乳糖酶
缺乏综合征
2） primary lactase deficiency初级的乳糖酶
缺乏综合征
3） secondary lactase deficiency二级乳糖酶
缺乏综合征
1） congenital lactase deficiency先天性乳糖酶
缺乏综合征
lactase is not present and symptoms will appear
when the patient is breast-fed.
人体内不存在乳糖酶, 当进行人乳哺育时
会出现综合征
The congenital form is very rare
这种症状极少见
2） primary lactase deficiency初级的乳糖酶缺
乏综合征
seen in most of the world's population
where the production of lactase
decreases or disappears from the age of
2 to the teenage years
在 2-10岁时，乳糖酶分泌下降或消失
? Persistent high lactase activity in adult
life occurs among relatively few ethnic
groups:
成年人体内乳糖酶活性一直处于高峰的人群：
? northern Europeans and their overseas
descendants北欧以及沿海后代
? a few African groups of pastoral tradition
Bedouins and other Saudi Arabs一些源于牧人
的非洲人, 贝都因人和沙特阿拉伯人
? certain groups from west India and
Pakistan西印度和巴基斯坦部分人群
? 3） secondary lactase deficiency二级乳糖酶缺
乏综合征
a consequence of pathological changes in
the gut mucosa,as seen in celiac
disease or inflammations.
乳糜泻或炎症引起内脏黏膜病变的结果
When the gut mucosa has regained its
normal appearance the lactase production
reappears
当内脏黏膜恢复正常，乳糖酶也开始重新分泌。
?The symptoms 症状：
Diarrhea 腹泻
gas production 产气
Colic 绞痛
? Control 控制措施：
avoid all products containing even
small amounts of lactose
避免食用任何含乳糖的食品
PREVALENCE
第四节 发病率
? The total prevalence of food allergy/food intolerance is not
known.
总发病率未知
? Estimates based on data from one country do not necessarily
reflect the prevalence of another country
在某个国家统计得到的数据并不能用到另一个国家, 因
为：
1） frequency and duration of breast feeding
母乳喂养的频率和持续时间
2） eating habits饮食习惯
3） flora植物群
Children
一、儿童
Food
（一）食品
? allergy to cow's milk,egg,and fish
predominantly begins before the second year
of age
对牛奶, 鸡蛋和鱼的过敏性主要发生 2岁以前
? allergy to fruit,legumes,and vegetables
predominantly begins after the second year.
对水果、豆类和蔬菜的过敏性主要发生在 2岁以后
? Table 1 Prevalence of Rhinitis and Oral
Itch in Danish School Children
丹麦学龄儿童中鼻炎和口腔发痒的发病率
Age (yr) Rhinitis (%) Oral itch（ %)
boys/girls boys/girls
5-7 9.0/5.7 0/0.3
8-10 8.5/7.1 0.8/1.1
11-13 14.0/8-5 1.9/1.5
14-16 17.3/13.0 2.9/2.0
Food Additives
（二）食品添加剂
? Adverse reactions to food additives are found in
1-2% of school children
1-2%学龄儿童对食品添加剂有不良反应
? The prevalence in younger children is not known.
至今不知小年龄儿童的发病率
Adults
二、成年人
Food
（一）食品
? In European studies the majority of
allergic food reactions in adults are
caused by fruits,vegetables,and nuts and
are related to pollen allergy
在欧洲，大部分成年人食品过敏性反应是由水果、
蔬菜和坚果引起的，且与花粉过敏症有关
? The prevalence is around 5%
发病率在 5%左右
?probably only 0,5% have symptoms
other than oral itch.
大约只有 0.5%不是口腔发痒症状
?The prevalence of allergy to milk,
egg,fish,etc,is around 0.2%，，
牛奶、鸡蛋、鱼等引起的过敏症发病率
大约为 0.2%
Food Additives
（二）食品添加剂
?The estimated frequency was 0.03-0.15%
1982年 EEC理论计算值：食品添加剂引起的
发病率为 0.03-0.15%
?In British, the prevalence
大不列颠人, 发病率为 0.026%
?Dutch 丹麦, 0.4%
Contact Allergens
（三）接触性过敏原
? 10 % Danish women have contact allergy
caused by nickel,
10%丹麦 妇女因镍造成接触性过敏症
? Up to 10% of these may benefit from a
nickel-restricted diet
其中 10%以上会因排除镍的饮食而改善
?What is contact allergens？
In dermally sensitized subjects
ingestion of the contact allergen may
cause skin flare reactions or other
symptoms,e.g.,in the
gastroinlestinal tract
皮肤敏感症受检者摄入接触性过敏原后会
导致皮肤潮间带反应或胃肠道症状等其他
症状。
?Contact Allergens：
fragrances 芳香物质
food flavors（ natural or synthetic） 食品风味物
Nickel 镍
Other Adverse Reactions
（四）其它不良反应
1） Celiac disease腹部疾病：
Cause,wheat gliadin and related proteins
起因：小麦麦醇溶蛋白和相关蛋白质
The prevalence, 0.2-0.5%
发病率,0.2-0.5%
2） lactase deficiency 乳糖酶缺乏综合征
Cause,Lack of lactase
起因：缺乏乳糖酶
The prevalence, varies from a few
percent in northern European countries
to almost the entire adult population in
Asia and Africa
发病率,从北欧国家到亚洲和非洲国家，
成年人发病率相差好几个百分点
Conclusion：
It is not known whether the prevalence
of food allergy or intolerance is
increasing
不清楚食品过敏 /不耐性的发病率是否有上
升趋势
The prevalence of pollen-related food allergies
has increased.
与花粉相关食品敏感症的发病率在提高 。
FOOD ALLERGENS
第五节 食品过敏原
Definition 定义
? Allergens are antigens that give rise to
allergy,
过敏原是能引起敏感的抗原
Where is food allergens from？
? Pollen花粉
? Mammals哺乳动物
? mites螨
? other insects其他昆虫
? foods食品
?Component：过敏原成分：
Proteins or glycoproteins with a molecular weight
from 3 to 90 kDa,the majority ranging from 10
to 40 kDa
已知结构的过敏原都是蛋白质或糖蛋白，分
子量从 3kDa到 90kDa，大部分在 10kDa到
40kDa之间
The identified allergens：
? the first three letters of the genus,space,the first
letter of the species,space,and an Arabic number,
? XXX X X
属 种 阿拉伯数字
? For example,Lol p 1 refers to the first pollen
allergen identified from Lolium perennc,or rye
grass
Lol p 1表示第一个花粉过敏原，来自 Lolium
perenne 或黑麦草
Classification 分类
"major",proteins for which 50% or more of the
allergic patients studied have specific IgE
“主要的,,能使 50%或以上被研究病人具有特异性 IgE
的蛋白质
"minor“,the remaining allergens are considered
minor
“次要的,,能使 50%以下的被研究病人具有特异性 IgE
的蛋白质
The Nature of Food Allergens
一、过敏原的种类
?To make a complete list of allergenic
foods on a global basis is virtually
impossible.
我们不可能列出一张食品过敏原清单
?Whether a food allergen causes
significant problems in a population
is dependent on several factors：
某种食品过敏原是否会在消费者中引起明显
的问题取决于以下几个方面：
（ a） the potency of the allergen
过敏原的效能
? some are much more frequent sensitizers lhan
others
有些抗体比其他抗体造成敏感症的次数更多,
e.g.,β -lactoglobulin in milk or ovomucoid from
egg white
如：牛奶中的 β-乳球蛋白或鸡蛋蛋白中的卵
类粘蛋白
（ b） the physiochemical properties
物化性质：
1） The chemical structure,i.e.,the amino acid sequence,
and the tertiary structure
化学结构如氨基酸序列, 蛋白质三级结构
2） heat stability 热稳定性
3） digestibility 可消化性
4） Structural relationship with epitopes from nonfood
allergens
非食品过敏原与抗原决定族之间的结构关系
（ c） the frequency of exposure
暴露的频率：
? In Europe allergy to rice and buckwheat is
uncommon.
在欧洲, 稻米和荞麦一般不引起敏感症
? In Japan rice and buckwheat are common
food allergens
在日本, 稻米和荞麦通常是食品过敏原 。
(d) the route of exposure
暴露途径
1 ） aero-allergens,grasses,pollen of trees and
herbs, house dust mites, o cat dander
飞散过敏原,草, 树或药草的花粉, 屋尘螨, 猫
毛发皮屑
2） work environment,baker
工作环境：面包工人
3） via the skin,Natural rubber (latex)
通过皮肤：天然橡胶
（ e） cross-reactions to aero-allergens
飞散过敏原的交叉反应
1) local species of grass,trees,and herbs and pollution
当地生长的草, 树以及药草种类
e.g.,Allergy to hazelnuts is common in areas with many
birch trees,where birch pollen hay lever is frequent
榛实敏感症一般发生在有许多桦树的地区, 在这些地
区经常发生桦树花粉热
2) air pollution空气污染
(f) the age at which the allergen is introduced
受过敏原入侵的个体年龄
? In early infancy an increased uptake of
antigen takes place at a time when the gut-
associated lymphoid tissue is still
incompletely developed
在幼年早期, 在与消化道相关淋巴组织还
没有发育好的时候, 抗原的摄入量相对
较高 。
Allergens of Animal Origin
二、来源于动物的过敏原
Milk （一）牛奶
1） Albumin,β -lactoglobulin,and immunoglobulins of
milk are the most important allergens in infants
婴儿：清蛋白,β-乳球蛋白和免疫球蛋白
2） In older children β -lactoglobulin,caseins,and I-
lactalbumin may be more reactive.
大孩子,β-乳球蛋白、酪蛋白和 ?-乳白蛋白
3） in adulthood,casein to be the most frequent allergen
成人期：酪蛋白
cross-reactions交叉反应
? The majority of patients with allergy to
cow's milk proteins will also react to
proteins from sheep's and goat's milk
大部分对牛奶蛋白质有敏感症的病人同样
对绵羊奶和山羊奶有敏感症
Cross-reactions between milk from these
species is not always present.
各种奶之间的交叉反应并不一直存在
Eggs
（二）鸡蛋
? the second most frequent food allergen in
small children after cow's milk
在小孩子中大概是仅次于牛奶的食品过敏原
? Egg white proteins are reported to elicit
allergic reactions more frequently than
egg yolk.
鸡蛋蛋白比蛋黄更易引起过敏反应
蛋黄中的主要过敏原
Protein
蛋白质
Name
分类名
molecular
weight
分子量 (kDa)
Content in egg white
鸡蛋白中的含量 (%)
Ovomucoid (*key)
卵类粘蛋白
Gal d 1 28000 11
Ovalbumin
卵清蛋白
Gal d 2 45000 54
Ovotransferrin
or conalbumin
卵铁传递蛋白或伴
清蛋白
Gal d 3 78000 12
Lysozyme
溶菌酶
Gal d 4 14000 3.4
? cross-reactions交叉反应,
? allergy to egg can be correlated to
allergy to bird feathers
鸡蛋敏感症与鸟类羽毛敏感症之间有相关性
? the major cross-reacting determinants
are the livetins from egg yolk.
主要交叉反应的决定因素是蛋黄中的卵黄蛋白
Allergens of Plant Origin
三、来源于植物的过敏原
The vegetable foods that most commonly
cause hypersensitivity symptoms
致敏性蔬菜种类
? hazelnut 榛实
? Walnut 胡桃
? Brazil nut 巴西坚果
? Apple 苹果
? Almond 杏仁
? Peach 桃子
? Plum 李子
? Cherry 樱桃
?Peanut 花生
?Peas 豌豆
?Carrot 胡萝卜
?parsley 欧芹
?Celery 芹菜
?Orange 橘子
?Strawberry 草莓
?Cereals 谷物
The ranking lists vary depending on
各种蔬菜致敏程度的影响因素
1） the age of the patients
病人的年龄
2） the methods of diagnosis
诊断方法以及
3 ） the geographic location of the
population
地理环境
Fruits,Nuts,and Vegetables
（一）水果、坚果和蔬菜
? More than 90% of patients with sensitization to
vegetable foods had concomitant sensitization to
pollen 90%
以上 的蔬菜敏感症总是伴随着花粉敏感症而来
? In a group of birch pollen allergies the patients with
additional hypersensitivity to nuts and apples had：
? 在一组同时有另外的坚果和苹果超敏性的桦树花
粉敏感症病人中
? (1) more severe symptoms during the pollen season
? 在花粉季节症状严重加重
? (2) higher values of IgE to birch and hazel pollen,
? 桦树和榛子花粉的 IgE值较高
? (3) a larger area of the skin prick test reactive to birch
and hazel pollen compared to the group without apple
and nut allergy
? 与那些没有坚果和苹果超敏性病人相比, 桦树和
榛子花粉的皮肤穿刺试验反应区域要大得多 。
?The symptoms 主要症状：
?Mainly from the mouth and pharynx,
with itching,swelling of the lips,
tongue,and throat,syndrome.
从嘴到咽发痒，嘴唇、舌头以及咽喉肿胀
?These symptoms are called the,oral
allergy”
“口腔敏感综合症,
?cross-reactions交叉反应,
1） A sensitization to mugwort pollens
and different spices,the so-called
mugwort-celery-spices syndrome,has
been reported
艾蒿及其不同种艾属植物的花粉有致敏
性，又称艾蒿 -芹菜 --香料综合症。
2） It was shown by prick,RAST studies,and RAST
inhibition experiments
皮肤穿刺,RSAT研究以及 RSAT抑制实验证明：
a celery-thermolabile allergen seems to be involved in
celery-birch-pollen-allergic patients
一种不耐热芹菜过敏原会导致芹菜 -桦树 -花粉敏感症
a thermostable allergen is involved in celery -mug wort-
allergic patients,
一种耐热过敏原会导致芹菜 -艾蒿敏感症
?Pollen-related food allergies are
thought to be caused by cross-
reactions of pollen-specific IgE
antibodies with epitopes of food
proteins.
花粉特异 IgE抗体与食品蛋白质的抗原决定
族发生交叉反应，导致了花粉相关食品
敏感症
Three distinct cross-reactive structures in
pollen and vegetable foods
花粉和蔬菜中的 3个明显交叉反应结构
1） Bet v l is the major birch pollen allergen
Bet v 1是主要的桦树花粉过敏原
? Allergens with cross-reactivity to Bet v 1,
与 Bet v 1有交叉反应的过敏原有：
? Apples 苹果
? Hazelnuts 榛实
? cherries 樱桃
?Pears 梨子
?Celery 艾蒿
?carrots 胡萝卜
2 ） Profilins are widely distributed in the plant
kingdom and have been identified as "plant pan
Allergens."
? Profilin广泛分布在植物王国, 被称为, 植物 pan
过敏原,
? 10 to 20% of the pollen-allergic patients are
sensitized to pronlins.
? 10-20%花粉敏感病人对 profilins敏感
? 3） Cross-reactions of allergen-specific IgE
antibodies can be caused by so-called
"cross-reactive carbohydrate determinants"
of food and pollen glycoproteins.
? 食品和花粉糖蛋白, 又称为, 交叉反
应碳水化合物决定物, 会引起 过敏原与
特异性 IgE抗体的交叉反应 。
Cereals
（二）谷物
?two major allergens,
两个主要过敏原 IgE：
one at 47 kDa
one at 20 kDa
?When challenged with double-blind,
placebo-controlled food challenge
DBPCFC实验证实
21% of the patients with suspected
allergy to cereals had symptoms
21%谷物过敏儿童有综合症状
8% had clinical reactions to only one
cereal
8%儿童只对一种谷物有临床反应
The majority of the children had
clinical reactions to wheat (76%)
大部分儿童（ 76%）对谷物有临床反应
Legumes （三）豆类
?Peanut allergy may be the most common
food allergy in the United States
在美国，花生敏感症是最常见的食品敏感症
Allergic reactions are often acute and
severe
过敏反应经常是急性和严重的
?The major peanut allergen：
主要的花生过敏原：
?
glycoprotein
糖蛋白
Ara h 1,molecular weight of 66 kDa
Ara h 2,molecular weight of 17 kDa
{
?The characteristic特征：
?heat stable 热稳定性
?a potential source of "hidden food
allergens
一种, 隐藏性食品过敏原, 的潜在资源
Natural Rubber (Latex)-Related Food Allergens
（四）与天然橡胶（乳胶）有关食品过敏原
? The latex allergens are proteins from the
rubber tree
乳汁过敏原是来自橡胶树的蛋白质
? Common antigenic determinants demonstrated
between latex and avocado,chestnut,and banana
乳汁与鳄梨, 栗子和香蕉之间存在共同的抗原定子
?Allergy to natural rubber (latex)
has become increasingly problematic
天然橡胶（乳汁）敏感症有上升趋势
?These reactions are severe,e.g.,
anaphylactic shock
许多反应是严重的，如过敏性休克
FOOD ADDITIVES
第六节 食品添加剂
?Chemically and functionally food
additives are a very heterogeneous
group of substances consisting of：
化学性的和功能性的食品添加剂的组成：
Enzymes 酶
Flavors 风味物
Colors 色素
Preservatives 防腐剂
Emulsifiers 乳化剂
Antioxidants 抗氧化剂
Sweeteners 甜味剂
Colors
一、色素
Azo Colors
（一） 含氮色素
? The azo colors cause adverse reactions,
会造成不良反应的含氮色素：
tartrazine酒石黄
sunset yellow落日黄
azorubin/carmoisin偶氮玉红
amaranth苋菜红
ponceau 4R丽春红 4R
Symptoms,
mainly on the skin and mainly urticaria
主要症状：皮肤风疹
? Tartrazine has been the additive of choice
when researchers have tried to elucidate the
mechanism of food-additive intolerance
酒石黄作为机理实验物
? a pharmacological effect of tartrazine and
other azo colors
酒石黄和其他含氮色素具有药物学影响
? pharmacological effect：
药物学影响：
? a large cumulative dose of tartrarine (200 mg) in
normal subjects resulted in a significant rise in plasma
and urinary histamine levels,
患者体内酒石黄积累到很高浓度时，血浆和尿液
中组胺浓度明显升高
? The histamine release was not accompanied by
systemic symptoms
全身组织综合症状导致组胺不能完全释放出来
Nonazo colors
（二） 无氮色素
? Nonazo colors could give adverse reactions,
会造成不良反应的无氮色素：
? Annatto 果红
? Indigo 靛蓝
? Carmine 胭脂红
? Erythrosine 赤藓红
? patent blue 专利蓝 (三苯甲烷系染料）
? Symptoms,
mainly on the skin and mainly urticaria
主要症状为皮肤风疹
Preservatives
二、防腐剂
Benzoic and Sorbic Acid
（一）安息香酸和山梨酸
causes of urticaria
造成接触性风疹
provoke itching and tingling in the mouth
出现口腔发痒和麻刺感
The mechanism is not known
其致病机制未知
Sulfites
（二） 亚硫酸盐
? symptoms 症状：
asthma 哮喘
anaphylactic reactions 皮肤过敏
symptoms on the skin 皮肤综合症
the likelihood of a reaction depend on：
致敏反应的可能性取决于,
? The nature of the food食品的特性
? the level of residual sulfite亚硫酸盐的残留水平
? the sensitivity of the patient病人的敏感性
? the form of residual sulfite亚硫酸盐的残留形式
? the mechanism of the sulfite-induced reaction
亚硫酸盐诱导反应机理
the cause of asthmatic reactions to
sulfltes in food
亚硫酸盐哮喘反应的原因：
?inhalation of sulfur dioxide
liberated during ingestion
食用时吸入了二氧化硫
?deficiency of sulfite oxidase
缺乏亚硫酸盐氧化酶
Metabisulfite 偏亚硫酸氢钠
? Metabisulfite-induced basophil histamine release in a
nonasthmatic patient
偏亚硫酸氢盐具有诱发嗜碱细胞释放组胺的功能
? developed urticaria and angi oedema following
provocation with sodium metabisulfite
偏亚硫酸氢钠激发会造成风疹和血管性水肿
an IgE-mediated reaction
偏亚硫酸氢钠的敏感性是一种以 IgE为媒介的反应
Flavor Enhancers and Flavors
三、风味促进剂和香精
Flavor Enhancers,Monosodium Glutamate
（一）风味促进剂：味精
?The result of monosodium glutamate
(MSG) was the Chinese restaurant
syndrome (CRS) and asthma。
味精会造成：
中国餐馆综合症（ CRS）
喘病症
1） symptoms of CRS 症状：
headache 头痛
a burning sensation along the back of the neck
沿着脖子背部的灼热感
chest tightness 胸闷
Nausea 作呕
Sweating 发汗
? Symptoms characteristic of the Chinese
restaurant syndrome can be provoked in a
limited number of individuals by high
concentrations of MSG,reaching a frequency
of about 30% at concentrations higher than 3
g/100 ml.
当味精浓度高于 3g/100ml时, 发病率为 30%
左右 。
? Where MSG is used in very high amounts.
Chinese restaurant syndrome can be provoked in
sensitive subjects.
当敏感受检者在食用了这类味精用量很高的食
品后, 会出现中国餐馆综合症
Wonton soup may contain up to 5 g of MSG per
bow
每碗馄饨 汤中含味精 5g
2） Asthma哮喘：
Whether MSG induces asthma is currently still
under debate.
目前对味精是否会诱导哮喘一说仍处于争论
之中 。
Flavors （二）香精
? Fragrance materials used in perfumes and other
cosmetic products can cause allergic contact
dermatitis.
香水和其他化妆品中的香味物质会引起敏感性接触皮
炎
? Many of the chemical substances in fragrances
are identical to chemicals found in food
flavors.
香味化学成分与食品香料化学物质在成分上是一致
? A number of the 30-40 chemicals in balsam
of Peru are identical or closely related to
chemicals present in spices and food
flavors (e.g.,vanillin,eugenol,cinnamic
aldehyde)
秘鲁香液与食品香料或风味物质（如香兰素、丁
子香酚、肉桂醛）有 30-40种相同的化学成分
? Balsam of Peru is used in the standard
patch test series in dermatology to test
for contact allergy to fragrance materials.
在皮肤病学的标准皮肤过敏试验中, 一般就用秘
鲁香液作为试验物进行试验 。
?Control 控制措施：
Forty-seven percent of the patients
placed on a balsam-restrictive diet
showed long-term improvement.
经香液排除饮食后,47%病人得到长期恢复。
?Difficulty 困难：
? Chemical flavor are found in all plants in
various amounts
大部分香精都能在植物中发现
? It was difficult to pinpoint one causative
chemical and to design an effective diet。
很难查明到底是哪种化学物质造成了过敏反应,
就难以有效设计饮食以避免过敏
Solvents,Propylene Glycol
四、溶剂：丙二醇
APPLICATION 应用
? a solvent of flavors 香精溶剂
food industry 食品工业
cosmetics 化妆品
Special application
?It gives cakes a nice soft texture
? 使蛋糕具有松软的组织结构
?The manufacturer to use it in
larger amounts than its function as
a solvent can justify..
制造商会因此超过其功能范围而大量使
用
?Symptoms 症状：
?Extensive exanthem (reddening of the
skin) within 3-16 h of ingestion
食用 3-16h后出现大范围皮疹（皮肤发红）
?Subsided without any medication in
24-48 h.
不进行治疗的话,24-48h后症状自行消退
Antioxidants
五、抗氧化剂
? BHA和 BHT：
flare-up contact allergy after
ingestion of BHA or BHT
爆发接触性敏感症
chronic urticaria
慢性风疹
Enzymes and Vegetable Gums
六、酶和植物胶
Characteristic,IgE-mediated allergic reactions
特点：以 IgE为媒介的过敏反应
Exposure pathway：
1） inhalation in the workplace
工作场所吸入
2） papain used as a meat tenderizer via the
respiratory route is also a possibility.
鸡肉肉质嫩化剂 ----木瓜蛋白酶通过呼吸道
THE END！
