No unique role for nausea attributed to eating a food in the recalled acquisition of sensory aversion for that food

Factors influencing adherence in a trial of early introduction of allergenic food

BACKGROUND

The Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy. The intervention was effective in the per-protocol analysis for allergy to 1 or more foods and for egg and peanut individually, but only 42% of early introduction group (EIG) children met the per-protocol criteria.

OBJECTIVE

We sought to identify which factors were responsible for nonadherence in the EAT study.

METHODS

Factors influencing adherence within the key early introduction period in the EIG (up to 6 months of age) were divided into enrollment and postenrollment factors, and their association with nonadherence was explored.

RESULTS

In an adjusted analysis, at enrollment, increased maternal age, nonwhite ethnicity, and lower maternal quality of life were independently and significantly associated with overall nonadherence in the EIG. Enrollment eczema and enrollment serum allergen-specific IgE sensitization to 1 or more foods (≥0.1 kU/L) were not related to overall nonadherence. After enrollment, 2 factors were significantly related to EIG overall nonadherence: parent-reported IgE-type symptoms with infant allergenic food consumption by 6 months of age and reported feeding difficulties by 4 months of age.

CONCLUSION

If early introduction of allergenic foods were to be considered a strategy to prevent food allergy, families of nonwhite ethnicity, those with older mothers, and those with infants with reported feeding difficulties or early-onset eczema would benefit from support to promote early and sustained consumption.

Why Do People Misdiagnose Themselves with Food Hypersensitivity? An Exploration of the Role of Biopsychosocial Factors

Up to 35% of people self-diagnose food allergy or intolerance (food hypersensitivity [FH]), or diagnose it in their child, and self-manage the condition rather than seek a clinical diagnosis. This is much higher than the latest FH prevalence rate, estimated to affect 2–5% of the general population. The actual prevalence rate may be underestimated due to the lack of diagnostic services; however, this can only account for a small proportion of the discrepancy because only a small percentage of self-reported FH can be clinically confirmed. Many people are therefore misdiagnosing their or their child’s symptoms as FH and needlessly removing foods from their or their child’s diet. There are a number of possible reasons for this misdiagnosis, which can be considered from a biopsychosocial perspective. Psychological factors include a confusion over the diagnosis, coincidental pairing of food and symptom, psychological or psychosomatic reactions, and taste aversions. There are also biological mechanisms that have not been fully considered in food allergy research that may be relevant, such as conditioning of the immune system or stress responses. A social context pertains to a greater awareness of FH due to media coverage and changes in food labelling laws. Any of these theories are plausible, but the research to date has a number of methodological issues. Most studies report on small self-selected samples recruited from clinics and there is a lack of general population data. Studies also tend to be cross-sectional, which does not allow cause and effect to be established. Future research needs to include longitudinal designs that incorporate qualitative elements to enable a detailed exploration of reasons why people self and misdiagnose FH.

Why Do People Misdiagnose Themselves with Food Hypersensitivity? An Exploration of the Role of Biopsychosocial Factors

Up to 35% of people self-diagnose food allergy or intolerance (food hypersensitivity [FH]), or diagnose it in their child, and self-manage the condition rather than seek a clinical diagnosis. This is much higher than the latest FH prevalence rate, estimated to affect 2–5% of the general population. The actual prevalence rate may be underestimated due to the lack of diagnostic services; however, this can only account for a small proportion of the discrepancy because only a small percentage of self-reported FH can be clinically confirmed. Many people are therefore misdiagnosing their or their child’s symptoms as FH and needlessly removing foods from their or their child’s diet. There are a number of possible reasons for this misdiagnosis, which can be considered from a biopsychosocial perspective. Psychological factors include a confusion over the diagnosis, coincidental pairing of food and symptom, psychological or psychosomatic reactions, and taste aversions. There are also biological mechanisms that have not been fully considered in food allergy research that may be relevant, such as conditioning of the immune system or stress responses. A social context pertains to a greater awareness of FH due to media coverage and changes in food labelling laws. Any of these theories are plausible, but the research to date has a number of methodological issues. Most studies report on small self-selected samples recruited from clinics and there is a lack of general population data. Studies also tend to be cross-sectional, which does not allow cause and effect to be established. Future research needs to include longitudinal designs that incorporate qualitative elements to enable a detailed exploration of reasons why people self and misdiagnose FH.

Situation-specific cognitive behavioural self-therapy for erroneously suspected allergy or intolerance to a food. A short self-assessment tool

The recall of personal experiences relevant to a claim of food allergy or food intolerance is assessed by a psychologically validated tool for evidence that the suspected food could have caused the adverse symptom suffered. The tool looks at recall from memory of a particular episode or episodes when food was followed by symptoms resulting in self-diagnosis of food allergy or intolerance compared to merely theoretical knowledge that such symptoms could arise after eating the food. If there is detailed recall of events that point to the food as a potential cause of the symptom and the symptom is sufficiently serious, the tool user is recommended to seek testing at an allergy clinic or by the appropriate specialist for a non-allergic sensitivity. If what is recalled does not support the logical possibility of a causal connection between eating that food and occurrence of the symptom, then the user of the tool is pointed to other potential sources of the problem. The user is also recommended to investigate remedies other than avoidance of the food that had been blamed.

Learned Liking Versus Inborn Delight

In this study, we separated for the first time the learned liking for a particular level of sweetness in a familiar drink from the infantile delight in sweetness as such (“the sweeter, the better”). It is widely assumed that sensing a liked food or drink evokes a pleasurable experience, but the only psychological evidence for this assumption has been tongue movements that are elicited specifically by sweet taste in animals and human neonates. We found that adults felt such movements in response to drinking juice at both their personally preferred level of sweetness and levels they deemed so sweet as to be undrinkable. Yet only the intolerably strong level of sweetness elicited enjoyment of the experienced movements, elevation of mood, and a sense of smiling. Hence, the pleasure that adults experience during ingestion could be exclusively linked with the congenital sweetness reflex that sends mother’s milk down an infant’s throat.

Aversão alimentar adquirida e qualidade de vida em mulheres com neoplasia mamária

OBJETIVO: Avaliar o comportamento alimentar de mulheres com câncer de mama submetidas à quimioterapia, e sua relação com a qualidade de vida destas pacientes. MÉTODOS: A partir de um ensaio clínico do tipo antes e depois, selecionou-se 25 mulheres do Hospital AC Camargo (São Paulo, Brasil) durante o período de outubro de 2005 a abril de 2006. As pacientes inclusas no estudo apresentavam diagnóstico de câncer de mama, com estadiamento I e II e indicação de tratamento quimioterápico adjuvante. Nos momentos T0 (antes) e T1 (após o tratamento quimioterápico), o comportamento alimentar (consumo e aversão alimentar) foi avaliado por três recordatórios 24 horas e um questionário Food Action, respectivamente. A qualidade de vida foi monitorada por meio do questionário Functional Assessment of Cancer Therapy-Breast. RESULTADOS: Após o tratamento quimioterápico (T1), o consumo de macro e micronutrientes não apresentou alterações significantes, mas o consumo de frutas e sucos aumentou (p=0,03). Perfil inverso foi observado em relação à preferência por café preto (p=0,01) e pelo grupo de bebidas (p<0,001). Alimentos gordurosos (38%), laticínios (23%), café preto (15%), chá (15%), chocolate (7%) e carne vermelha (7%) foram os principais alimentos associados ao desconforto das pacientes. Análises de qualidade de vida mostraram que o tratamento quimioterápico promoveu significante redução no bem estar físico (p<0,01). Após o mesmo, algumas variáveis do comportamento alimentar foram significantemente correlacionadas com os parâmetros de qualidade de vida. CONCLUSÃO: A relação bilateral entre comportamento alimentar e qualidade de vida foi modificada negativamente pelo tratamento quimioterápico.