Uncommon Food Allergy - Dissertation Example

?A Study of Uncommon Food Allergy The study will venture to examine uncommon food allergy together with the symptoms, their level of severity, how the allergy and the symptoms are managed, and if there is an association between the level of severity of the symptom and the use of non-use of a medical intervention. A total of 377 respondents to be selected by purposive sampling will be requested to participate in the study. The study will be carried out using descriptive-quantitative method utilising survey methodology through a paper-and-pen questionnaire survey. Data will be statistically treated using descriptive and inferential measures, particularly simple mean, standard deviation, frequency distribution, independent samples t-test and supplemented by Levene’s test of homogeneity of variance. 1.0. Introduction A true food allergy, according to Duyff (2003), is also referred to as food hypersensitivity, where the immune system to react to harmless substances present in food even though a person is not technically sick. These substances are generally termed as allergens, are usually proteins from some food which sets off the body’s immune system to react by the production of immunoglobulin E (IgE) antibodies. The IgE antibodies activate the release of natural body histamines to counter the allergic reaction. An individual experiences these internal bodily processes as the uncomfortable symptoms associated with allergy, such as itching, running nose, nausea, palpitation, and in worst cases anaphylaxis (Duyff, 2006) Statistics gathered by Duyff (2006) revealed that one in every three adults are allergic to milk, whereas the National Health Institute estimated that only four out of 100 or about 11 million Americans have food allergies. Approximately 60% of the food allergies are seafood allergies, and about 30% are peanut and tree nut allergies. The remaining percentage are allergies caused by uncommon food allergens. However, the figures are increasing and this is a cause for alarm, specially so that “any food has the potential to cause an allergic reaction” (Munoz-Furlong and Sampson, 2003:408). There are food allergies that are, however, triggered by uncommon allergens such as spinach, celery, avocado, tomato, wheat (Asero, et al., 2009), mustard (Figueroa, et al., 2005); lupine flour (De Jong, et al., 2010), pomegranate, in the case of this researcher, and many others. Duyff (2006) maintained that food allergies are frequently self-diagnosed, and declared on the basis of popular literature or common symptoms. 1.1. Research Problem A preliminary survey of existing literature demonstrated that studies on allergy and uncommon allergy focused on one or a related group of allergies, or in some studies symptoms experienced and how the uncommon food allergy is managed. Specifically, the following research problems will be addressed: 1.1.1. What are the uncommon food allergies of the respondents? 1.1.2. What symptoms are experienced by respondents who have uncommon food allergies? 1.1.3. What is the level of severity of the symptoms? 1.1.4. How are the allergy and the symptoms managed? 1.1.5. Are there significant differences in the severity of the symptoms experienced and the application of medical interventions? 1.2. Research Hypothesis The null hypothesis that “there are no significant differences in the severity of the symptoms experienced and the application of medical interventions” will be tested using a 0.05 level of significance and a two-tailed analysis. 1.3. Terms of Reference The study is being conducted to collate evidence about uncommon food allergy, the symptoms and how the condition is managed. A summary of the findings of existing studies have also been presented. As earlier mentioned, none of the existing studies so far ventured to collate and group uncommon allergy study data. Hence, this library research is important because this is the first study so far which attempted efforts to synthesize existing knowledge on uncommon food allergy in a form which can readily present comprehensive data on symptoms and their management. The unique selling point of this study are the comparative presentation of research data on uncommon food allergy, their symptoms compared with common food allergies described in literature. Relationships which will be derived from this study will be a significant contribution in the understanding of uncommon food allergy. 1.4. Review of Related Literature Food allergy is described as a growing public health issue, characterized by long-term disease implications linked to changing dietary patterns, intestinal commensal bacteria and vehicular pollution. It is suggested that environmental changes trigger modifications in gene expression, causing potential hereditary complications. It has been observed that children suffering from food allergies face the risk of having the disorder for a longer duration compared to their parents. Moreover, the rising incidence of maternal allergy increases the risk of inheriting the condition (Prescott & Allen 2011). Figueroa et al. (2005) investigated the effects of mustard IgE-mediated allergy, as well as its cross-reactivities to determine if mustard allergy is considered rare as commonly thought. Using questionnaires, skin-prick tests, serum extraction, and double-blind placebo controlled food challenges, the authors were able to determine a significant link between mustard hypersensitivity and mugwort pollen sensitization with partial cross-reactivity. In addition, all subjects reveal sensitization and cross-reactivity to mustard- and cabbage-related plants. The results also show significant associations with nuts, leguminous plants, corn, and members of the Rosaceae family of plants such as apples, plums, apricots, roses, and hawthorns. It was concluded that mustard allergy is a common allergy due to its significant associations with mugwort pollen and several plant-derived food allergens (Figueroa et al. 2005). De Jong, Van Maaren, Vlieg-Boerstra, Dubois, De Groot & Van Wijk (2010) investigated the clinical relevance of sensitization to lupine flour by conducting skin-prick tests for soy, peanut, and lupine flour on 372 subjects attending food allergy clinics with suspected food allergy. For subjects that tested positive for lupine flour sensitization, a double-blind placebo-controlled food challenge was conducted. Out of the nine that tested positive for lupine flour sensitization, eight turned out negative for lupine flour allergy. Only one subject showed significant symptoms of lupine flour allergy. In addition, all nine subjects were also sensitized to peanut and soy. The authors concluded that lupine flour allergy is uncommon, as evidenced by the eight subjects which were able to consume lupine flour without showing allergy symptoms. Moreover, it was determined that sensitization for lupine flour is not clinically relevant and may only have been brought about by cross-sensitization to peanut products (De Jong, Van Maaren, Vlieg-Boerstra, Dubois, De Groot & Van Wijk 2010). Asero et al. (2009) examined the leading causes of food-induced anaphylaxis in Italy by analysing the frequency and causes of anaphylaxis in 19 allergy centres throughout Italy in 2007. Out of 1,110 patients, fifty-eight experienced at least one episode of anaphylaxis. The foods attributed to an anaphylaptic episode are broken down as follows: plant-derived lipid transfer protein (19); shrimp (10); tree nuts (9); legumes, except for peanut (4); seeds (2); peanut (1); spinach (1); celery (1); buckwheat (1); wheat (1); avocado (1); tomato (1); fish (1); meat (1); and Anisakis, a parasitic nematode found in fish.         Lipid transfer protein is identified as the most-important allergen which causes anaphylactic episodes whereas the consumption of peaches has been attributed to 13 out of 19 episodes among LPT-sensitized patients. On the other hand, peanuts are considered uncommon in terms of inducing anaphylactic episode (Asero et al. 2009).         MacDougall, Cant & Colver (2002) investigated the incidence of severe and fatal allergic reactions among children in UK and Ireland by reviewing fatality statistics from 1990 to 1998. In addition, data from the British Paediatric Surveillance Unit from March 1998 to February 2000 was also utilized to determine cases of severe and fatal reactions. Over the 10-year period, eight cases were identified where children died due to allergic reaction. Milk was identified on half of the cases while the other half was attributed to epinephrine-related causes. In addition, six near-fatal cases and 49 severe cases were identified for the last 2 years. Peanut-induced reaction accounted for 10 out of the 49 severe cases. It was also determined that existing asthma increases the risk of severe reactions. Kaukinen, Turjanmaa, Maki, Partanen, Venalainen, Reunala & Collin (2000) examined the relationship between cereal intolerance, coeliac disease, and cereal allergy. Abdominal complaints after the consumption of cereals have been attributed to overt celiac disease. However, tests revealed that cereal intolerance is not a specific marker of celiac disease. Moreover, tests for cereal allergy should be considered before initiating any treatments. This applies even for adult patients. Sampson (2005) argued that even though 1 out of 4 adults believe that food allergy afflicts them or their children, only an estimated 6 to 8 percent of children actually develop food allergy in the first 3 years. In addition, most children develop a certain level of tolerance over time. Food allergy symptoms affect the skin, digestive system, and breathing. Moreover, the severity of symptoms depends on immunoglobulin mediation.         To detect food sensitization, a skin-prick test is usually performed. However, a double-blind placebo-controlled food challenge or DBPCFC test is a more reliable indicator for diagnosing food allergies. Recent studies suggest the prediction of DBPCFC results through quantitative immunoglobulin measurement. Moreover, combining immunoglobulin measurement with medical history assessment has the potential of reducing the necessity of conducting DBPCFC tests. Another improvement in allergy diagnosis involves immunoglobulin-binding mapping techniques for food allergens to help identify children with persistent food allergy (Sampson 2005). Roehr et al. (2004) investigated the incidence of food allergy and non-allergic food hypersensitivity among children. Data was collected from 739 mail respondents and 154 volunteers to evaluate perception of food-induced symptoms, evaluate food allergens indicated, evaluate parent observations, and determine subgroups which show vulnerability to food-induced allergy and non-allergic food hypersensitivity. Research instruments utilized in the study comprised of mailed questionnaires, telephone interviews, physical examination, skin-prick tests, specific serum immunoglobulin, and standardized, controlled, and blinded oral food challenges.         Results of the study reveal oral allergy syndrome as the most prevalent symptom. Oral challenge tests show the following foods as the most common sources of symptoms: apple, hazelnut, kiwi, carrot, soy, and wheat. In terms of self-reporting food-related symptoms, only one out of ten respondents reported positive. These findings support the findings of prior studies which revealed a discrepancy between self-reported food symptoms and physician diagnosed food hypersensitivity (Roehr et al. 2004). Van der Velde et al. (2009) described food allergy as the leading cause of anaphylaxis in medical emergency cases. About four percent of the general population suffers from this condition wherein the only reliable form of therapy is to avoid the cause of allergic reaction and the administration of medication during emergencies. Unfortunately for allergy patients, being in a state of fear, complying with dietary limitations, and observing social restrictions usually result to degradation of quality of life. Bahna (2000) evaluated existing literature on uncommon food hypersensitivity reactions in relation to its source, route of exposure, and clinical manifestations. Results of the review revealed that food allergy sources may be found in other food products which were knowingly or accidentally incorporated during the manufacturing process. Food allergens may also find its way into non-food product. Meanwhile, food allergens may elicit a systemic reaction through non-conventional routes such as odour, skin contact, inhalation, and mucous membrane exposure. Moreover, clinical manifestations of allergic reactions are not confined to gastrointestinal, cutaneous, and respiratory means. 2.0. Materials and Methods The study is a library or a desk research, which entail the use of the following materials: library facilities and or Internet-based book and journal databases, as well as a personal computer or a laptop for the encoding of data and preparation of the documentation. The intended methodology is descriptive-quantitative using survey methodology by way of a survey questionnaire. Respondents will be selected using purposive sampling. In a purposive sampling, study participants are chosen based on the judgment of the researcher or proponent by virtue of the respondents’ unique position in the target population. In this study, the identified target population are individuals with uncommon food allergy. Purposive sampling is the sampling method of choice because the respondents will have to be people who have experienced uncommon food allergy and are willing to participate in the study. The minimum required number of respondents of the study was already computed using a Web-based sample size calculator (Raosoft, 2004). The parameters used in the calculation were the following: identified population, 11,000,000; level of significance, 95%; margin of error, 5%; and response distribution, 50%. The minimum required sample size for the study is 377. Respondents will be recruited with the assistance of physicians and health personnel from allergy clinics. Once the prospective respondents were identified, they will be appraised of the details of the study based on the provisions of the consent form. In this discussion, the respondents will be requested to voluntarily participate in the study with assurance that the pillars of research ethics will be observed. Particularly, anonymity, confidentiality, privacy, and protection from risk of harm will be explained in detail. Respondents who will voluntarily participate will be given the assurance that they may withdraw from the research anytime they feel they need to. Consent forms will be signed by the researcher, the respondents, and two witnesses. Copies of the signed informed consent forms will be provided to the respondent. The questionnaire will consist of two main parts and a total of 20 items. The first part will enquire about the respondents’ demographics, particularly: gender, age, ethnicity, socio-economic status, religious affiliation and educational attainment. The second part of the questionnaire will be the survey proper which will contain 14 items. The questionnaire will be validated using internal consistency reliability through pilot testing among a comparable sample of 10 respondents also selected through purposive sampling. Number coded responses during the pilot testing will be confirmed using reliability analysis of SPSS Statistics (2008). A Cronbach alpha of at least 0.70 is required so that the questionnaire may be pronounced to have internal consistency reliability. The same questionnaire will also be subjected to face and content validity using peer and expert opinions, respectively. Data will be analyzed using both descriptive and inferential statistical measures. The following table details the specific data analysis technique to be used. Table 1. Data Analysis Techniques for each Research Problem Research Problem Data Analysis What are the uncommon food allergies of the respondents? Frequency and percentage distribution What symptoms are experienced by respondents who have uncommon food allergies? Frequency and percentage distribution What is the level of severity of the symptoms? Simple mean and standard deviation How are the allergy and the symptoms managed? Frequency and percentage distribution Are there significant differences in the severity of the symptoms experienced and the application of medical interventions? Since the categories for application of medical intervention is either with or without medical intervention, independent samples t-test will be used, supplemented by Levene’s test for homogeneity of variance. 3.0. Results Results of the five research problems will be presented as depicted in Table 2. Table 2. Presentation of Research Findings Research Problem Data Analysis What are the uncommon food allergies of the respondents? Pie chart What symptoms are experienced by respondents who have uncommon food allergies? Pie chart What is the level of severity of the symptoms? Tabulation How are the allergy and the symptoms managed? Tabulation Are there significant differences in the severity of the symptoms experienced and the application of medical interventions? Tabulation Each pie chart and tabulation of the findings or research results will be comprehensively discussed together with the implications of the findings and the directions for future research. A summary of the findings will be presented to conclude this section. 4.0. Conclusion and Discussion The foregoing literature review demonstrated that indeed, people experience uncommon forms of allergy from pomegranate, to some forms of wheat to seemingly harmless vegetables and fruits. Symptoms were found to vary from one form of allergy to the other, but the most alarming consequence of some of the uncommon forms of allergy are anaphylactic shock and in some cases death of the individual. While the current study does not promise to provide the solution to the substantial number of allergies from uncommon and sometimes ridiculous allergens, it proposes to discover from the experience of people who suffer from uncommon food allergy if the level of severity of the symptoms demonstrated are associated with a medical intervention or with a non-medical intervention. The findings which may be revealed from the study should be interesting from the point of view that a general categorisation of a large-sample study may illustrate some trends which may not have been explored and discovered in previous studies. On the whole, it is believed that the study will be a significant contribution in the reservoir of knowledge an uncommon food allergy. 5.0 References Asero, R et al. (2009) Causes of Food-Induced Anaphylaxis in Italian Adults: A Multi-Centre Study. International Archives of Allergy and Immunology, 150(3), 271-277. Bahna, SL (2000) Unusual Presentations of Food Allergy. Annals of Allergy, Asthma, & Immunology, 86(4), 414-420. De Jong, NW et al. (2010) Sensitization to Lupine Flour: Is It Clinically Relevant? Clinical and Experimental Allergy: Journal Of The British Society For Allergy And Clinical Immunology, 40(10), 1571-1577. Duyff RL (2006) American Dietetic Association Complete Food and Nutrition Guide, 3rd ed. Hoboken, NJ: Wiley & Sons. Figueroa, J et al. (2005) Mustard Allergy Confirmed by Double-Blind Placebo-Controlled Food Challenges: Clinical Features and Cross-Reactivity with Mugwort Pollen and Plant-Derived Foods. Allergy, 60(1), 48-55. Kaukinen, K et al. (2000) Intolerance to Cereals is Not Specific for Coeliac Disease. Scandinavian Journal of Gastroenterology, 35(9), 942-946. MacDougall, CF, Cant, AJ & Colver, AF (2002) How Dangerous is Food Allergy in Childhood? The Incidence of Severe and Fatal Allergic Reactions Across the UK and Ireland. Archives of Disease in Childhood, 86, 236-239. Munoz-Furlong, A and Sampson, HA (2003) Management of food allergy. In  DD Metcalfe, HA Sampson, RA Simon (eds), Food Allergy: Adverse Reactions to Food and Food Additives. Malden, MA: Blackwell Science, 408-424. Prescott, S & Allen, KJ (2011) Food Allergy: Riding the Second Wave of the Allergy Epidemic. Pediatric Allergy And Immunology: Official Publication Of The European Society Of Pediatric Allergy And Immunology, 22(2), 155-160. Raosoft (2004), Sample Size Calculator, viewed 1 March 2011, http://www.raosoft.com/samplesize.html Roehr, CC et al. (2004) Food Allergy and Non-Allergic Food Hypersensitivity in Children and Adolescents. Clinical and Experimental Allergy, 34(10), 1534-1541. Sampson, HA (2005) Food Allergy – Accurately Identifying Clinical Reactivity. Allergy, 60(Supplement 79), 19-24. SPSS Statistics (2008), [CD-ROM],  Version 17, IBM Corporation, Chicago, IL. Van der Velde, JL et al. (2009) Test-Retest Reliability of the Food Allergy Quality of Life Questionnaires (FAQLQ) for Children, Adolescents, and Adults. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 18(2), 245-251. 6.0. Appendices 6.1. Time Management Chart Date Activity May 2011 Requests June 2011 Approval of Requests July 2011 Pilot Testing August 2011 Instrument Finalisation September 2011 Questionnaire Administration and Retrieval October 2011 November 2011 Data Processing December 2011 January 2012 Data Analysis February 2012 March 2012 Writing-up April 2012 May 2012 6.2. Risk Assessment Computer security risks are described as events or actions that result to damages and losses directed at computer hardware, software, and information. In this study, risks identified include unauthorized access of information by unauthorized persons, as well as theft of computer equipment. In addition, unauthorized access may also compromise the integrity of software used during the duration of the study. Therefore, it is crucial that measures be taken up to maintain the security and integrity of computer equipment, software and the research data itself. Among the priority measures which will be implemented to mitigate data security risk are: utilisation of a two-level authentication system in the access of the personal computer / laptop where data for the study will be stored. The MS Word data file will also be password protected. Likewise, the questionnaires will be kept under lock and key until the findings of the study is disseminated. After the study is defended and disseminated, the questionnaires will be shredded and incinerated. Only the password protected files will be kept for storage whereas MS Excel and SPSS files will be deleted to ensure that the privacy, confidentiality and anonymity of the study respondents are protected. Read More