【正文】 n of grouped vesicles on an erythematous ground 在紅斑狀范圍內(nèi)出現(xiàn)成群泡樣出疹 ? Some DH patients, even without gastrointestinal symptoms, may have villous atrophy similar to that seen in celiac disease 有些 DH病人甚至在沒有出現(xiàn)胃腸道綜合癥的情況下 ， 也會出現(xiàn)與乳糜瀉類似的絨毛狀萎縮癥 ， 也就是說 DH與 CD之間有關(guān)連 。 ? The cutaneous manifestations may or may not respond to a glutenfree diet 飲食中排除麥醇溶蛋白可能會 、 也有可能不會改善皮膚癥狀 。 Eosinophilic Gastroenteritis （四）嗜酸性胃腸炎 ?Definition 定義： elevated eosinophil counts in blood and tissue eosinophilia with release of eosinophii major basic protein 釋放嗜曙紅細胞主要基本蛋白質(zhì)后，血液中嗜曙紅細胞和嗜曙紅血球增多的間質(zhì)組織內(nèi)嗜曙紅細胞計數(shù)值升高 ? Clinical manifestations 臨床癥狀： ? vomiting 嘔吐 ? abdominal pain 腹部疼痛 ? Diarrhea 腹瀉 ? malabsorption 吸收不良 ? bowel obstruction 腸阻塞 ? Ascites 腹水 ? The cause of EG is unknown 起因還不清楚 ? food hypersensitivity has been suggested EG可能由食品超敏性引起 Utcerative Colitis （五）潰瘍性結(jié)腸炎 ? Definition 定義： an inflammatory bowel disease of unknown origin 一種不明起因的炎癥性腸病 ? No adverse food reactions have been shown as causative of UC 還不能證明食品不良反應(yīng)會造成 UC Allergic Vasculitis （六） 變應(yīng)性脈管炎 ?Cause 起因： foods and food additives 食品及其添加劑 ?Symptom 癥狀： allergic purpura (widespread hemorrhagic macules and papules, mainly on the lower legs) demonstrated by single challenges 變應(yīng)性紫癜（分布廣泛的出血性斑丘疹，主要出現(xiàn)在腿的下部） Food Intolerance 三、 食品不耐性 Lactase Deficiency 乳糖酶缺乏綜合征 ?Definition 定義： Lack of the enzyme that cleaves milk sugar, lactose, gives rise to adverse reactions when lactose is consumed. 當攝入乳糖時，由于體內(nèi)缺乏一種能將牛奶糖質(zhì) 乳糖水解的酶，從而產(chǎn)生不良反應(yīng) ? The only food of which lactose is a natural constituent is milk ( g/100 ml cows milk). 天然含乳糖的唯一食品是牛奶 （ 牛奶 ） ?Classification 分類： 1） congenital lactase deficiency先天性乳糖酶缺乏綜合征 2） primary lactase deficiency初級的乳糖酶缺乏綜合征 3） secondary lactase deficiency二級乳糖酶缺乏綜合征 1） congenital lactase deficiency先天性乳糖酶缺乏綜合征 lactase is not present and symptoms will appear when the patient is breastfed. 人體內(nèi)不存在乳糖酶 ， 當進行人乳哺育時會出現(xiàn)綜合征 The congenital form is very rare 這種癥狀極少見 2） primary lactase deficiency初級的乳糖酶缺乏綜合征 seen in most of the world39。s population where the production of lactase decreases or disappears from the age of 2 to the teenage years 在 210歲時，乳糖酶分泌下降或消失 ? Persistent high lactase activity in adult life occurs among relatively few ethnic groups: 成年人體內(nèi)乳糖酶活性一直處于高峰的人群： ? northern Europeans and their overseas descendants北歐以及沿海后代 ? a few African groups of pastoral tradition Bedouins and other Saudi Arabs一些源于牧人的非洲人 、 貝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二級乳糖酶缺乏綜合征 a consequence of pathological changes in the gut mucosa, as seen in celiac disease or inflammations. 乳糜瀉或炎癥引起內(nèi)臟黏膜病變的結(jié)果 When the gut mucosa has regained its normal appearance the lactase production reappears 當內(nèi)臟黏膜恢復正常，乳糖酶也開始重新分泌。 ?The symptoms 癥狀： Diarrhea 腹瀉 gas production 產(chǎn)氣 Colic 絞痛 ? 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 第四節(jié) 發(fā)病率 ? The total prevalence of food allergy/food intolerance is not known. 總發(fā)病率未知 ? Estimates based on data from one country do not necessarily reflect the prevalence of another country 在某個國家統(tǒng)計得到的數(shù)據(jù)并不能用到另一個國家 ， 因為： 1） frequency and duration of breast feeding 母乳喂養(yǎng)的頻率和持續(xù)時間 2） eating habits飲食習慣 3） flora植物群 Children 一、兒童 Food （一）食品 ? allergy to cow39。s milk, egg, and fish predominantly begins before the second year of age 對牛奶 、 雞蛋和魚的過敏性主要發(fā)生 2歲以前 ? allergy to fruit, legumes, and vegetables predominantly begins after the second year. 對水果、豆類和蔬菜的過敏性主要發(fā)生在 2歲以后 ? Table 1 Prevalence of Rhinitis and Oral Itch in Danish School Children 丹麥學齡兒童中鼻炎和口腔發(fā)癢的發(fā)病率 Age (yr) Rhinitis (%) Oral itch（ %) boys/girls boys/girls 57 810 1113 1416 Food Additives （二）食品添加劑 ? Adverse reactions to food additives are found in 12% of school children 12%學齡兒童對食品添加劑有不良反應(yīng) ? The prevalence in younger children is not known. 至今不知小年齡兒童的發(fā)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 在歐洲，大部分成年人食品過敏性反應(yīng)是由水果、蔬菜和堅果引起的，且與花粉過敏癥有關(guān) ? The prevalence is around 5% 發(fā)病率在 5%左右 ? probably only 0,5% have symptoms other than oral itch. 大約只有 %不是口腔發(fā)癢癥狀 ? The prevalence of allergy to milk, egg, fish. etc. is around %，牛奶、雞蛋、魚等引起的過敏癥發(fā)病率大約為 % Food Additives （二）食品添加劑 ? The estimated frequency was % 1982年 EEC理論計算值：食品添加劑引起的發(fā)病率為 % ? In British ： the prevalence 大不列顛人 ： 發(fā)病率為 % ? Dutch 丹麥 ： % Contact Allergens （三）接觸性過敏原 ? 10 % Danish women have contact allergy caused by nickel. 10%丹麥 婦女因鎳造成接觸性過敏癥 ? Up to 10% of these may benefit from a nickelrestricted diet 其中 10%以上會因排除鎳的飲食而改善 ?What is contact allergens？