食品安全5课程学习.pptx

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1、会计学1食品安全食品安全5第一页，共140页。n nPREVALENCEPREVALENCE第四节第四节 发病率发病率n nFOOD ALLERGENSFOOD ALLERGENS第五节第五节 食品食品(shp(shp n)n)过敏原过敏原n nFOOD ADDITIVESFOOD ADDITIVES第六节第六节 食品食品(shp(shp n)n)添加剂添加剂n nFOOD LABELING IN RELATION FOOD LABELING IN RELATION TOTO FOOD SENSITIVITIES FOOD SENSITIVITIES 第七节第七节 与食品与食品(shp(shp

2、 n)n)过敏性有关的食过敏性有关的食品品(shp(shp n)n)标签标签第2页/共140页第二页，共140页。DEFINITION AND MECHANISMS OF ADVERSE FOOD REACTION第一节第一节 食品食品(shpn)不不良反应的定义和机理良反应的定义和机理第3页/共140页第三页，共140页。Fig.1 Classification of foods proposed by EAACI图1 EAACI对食品(shpn)的分级第4页/共140页第四页，共140页。toxic food reactions 食品食品毒性毒性(d xn)反应反应n nA classic

3、al toxic food reaction is scombroid fish poisoning,due to large amounts of histamine n n 鲭亚目鱼组胺(z n)中毒是典型的食品毒性反应。第5页/共140页第五页，共140页。Food intolerance 食品食品(shpn)不不耐性耐性 n nenzymatic(resulting from an enzymatic defect,e.g.,lactase deficiency),enzymatic(resulting from an enzymatic defect,e.g.,lactase def

4、iciency),n n “酶促性的酶促性的”（因酶缺陷（因酶缺陷(quxin)(quxin)造成，如乳糖酶缺乏症）造成，如乳糖酶缺乏症）n npharmacological(depending on the direct effect of,e.g.,vaso-active amines naturally found in foods)pharmacological(depending on the direct effect of,e.g.,vaso-active amines naturally found in foods)n n “药理学的药理学的”（取决于直接效应，如食品中天然存

5、在的血管活性胺）（取决于直接效应，如食品中天然存在的血管活性胺）n n“Undefined“Undefined不明确的不明确的”第6页/共140页第六页，共140页。SYMPTOMS OF ADVERSE FOOD REACTIONS第二节第二节 食品食品(shpn)不不良反应的症状良反应的症状第7页/共140页第七页，共140页。IgE-Mediated Food Allergy一、以一、以IgE-为媒介的食为媒介的食品品(shpn)敏感症敏感症 第8页/共140页第八页，共140页。Characteristic 特征特征(tzhng)Clinical manifestations of I

6、gE-mediated food allergy can Clinical manifestations of IgE-mediated food allergy can remain localized at the site of the primary direct contact,remain localized at the site of the primary direct contact,i.e.,i.e.,一直保持在最初的直接接触一直保持在最初的直接接触(jich)(jich)部位部位 the mouth the mouth 嘴嘴throat(oral allergy syn

7、drome)throat(oral allergy syndrome)咽喉（口腔敏感综合症）咽喉（口腔敏感综合症）the gastroiniesrinal tract(isolated gastrointestinal food allergy)the gastroiniesrinal tract(isolated gastrointestinal food allergy)胃肠道（单独的胃肠道食品敏感症）胃肠道（单独的胃肠道食品敏感症）第9页/共140页第九页，共140页。Skin Respiratory tract GI tract Cardievascular S.皮肤 呼吸道 胃肠道

8、心脏血管(xugun)系统45%25%20%10%Figure 2 Classical symptoms of IgE-mediated food ailergy图图2 以以IgE为媒介为媒介(miji)的食品敏感综合症分布的食品敏感综合症分布第10页/共140页第十页，共140页。Oral Allergy Syndrome Oral Allergy Syndrome（一）口腔敏感（一）口腔敏感(mngn)(mngn)综合病综合病症症 n nAllergen:Allergen:fresh fresh foods(foods(fruits fruits and and vegetables)ve

9、getables)n n 过过过过敏敏敏敏原原原原：新新新新鲜鲜鲜鲜(xn(xn xin)xin)食食食食品品品品（如如如如水水水水果和蔬菜）果和蔬菜）果和蔬菜）果和蔬菜）第11页/共140页第十一页，共140页。n nSymptom Symptom 症状：症状：症状：症状：n nItching of the lips,mouth,palateItching of the lips,mouth,palate，throat throatn n 嘴唇、嘴、上腭咽喉等处立即发痒嘴唇、嘴、上腭咽喉等处立即发痒嘴唇、嘴、上腭咽喉等处立即发痒嘴唇、嘴、上腭咽喉等处立即发痒n nHoarseness Hoa

10、rseness and/or and/or swelling swelling of of the the lips,lips,tongue,uvula,and larynx tongue,uvula,and larynx n n 嗓嗓嗓嗓音音音音嘶嘶嘶嘶哑哑哑哑，嘴嘴嘴嘴唇唇唇唇、舌舌舌舌头头头头(sh(sh tou)tou)、小小小小舌舌舌舌、喉等肿胀喉等肿胀喉等肿胀喉等肿胀第12页/共140页第十二页，共140页。Allergic Reactions After Allergic Reactions After Ingestion of Food Ingestion of Food（二）

11、摄入食品（二）摄入食品(shpn)(shpn)后的过后的过敏反应敏反应 n nSymptom 症状：症状：n n1）The main symptoms of gastrointestinal food allergy are vomiting,nausea,diarrhea,and abdominal pains(colics or cramps).n n胃肠道主要症状胃肠道主要症状:呕吐、反胃、呕吐、反胃、腹泻以及腹部腹泻以及腹部(f b)疼痛（绞疼痛（绞痛或痛性痉挛）；痛或痛性痉挛）；第13页/共140页第十三页，共140页。2)Skin reactions include local o

12、r generalized pruritus,flush,urticaria,angioedema.morbilliform exanthema,and flare-up of atopic dermatitis 皮肤反应：局部(jb)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；第14页/共140页第十四页，共140页。3)The symptoms of the upper and the lower respiratory tract are rhinitis(sneezing,pruritus of the nose,nasal stuffiness,a

13、nd 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(b si)）、喉肿、咳嗽、喘息以及支气管哮喘；第15页/共140页第十五页，共140页。4)Itching,redness,and watering eyes(conjunctivitis)发痒、充血(chngxu)以及眼睛流泪（结膜炎）.第16页/共140页第十六页，共140页。Allergic Reactions Allergic Reactions After Inhalati

14、on of After Inhalation of Food Food（三）吸入食品（三）吸入食品(shpn)(shpn)后的过敏反应后的过敏反应n nSymptom Symptom 症状症状症状症状(zhngzhung)(zhngzhung)：n nrespiratory symptoms respiratory symptoms 呼吸道综合症呼吸道综合症呼吸道综合症呼吸道综合症 第17页/共140页第十七页，共140页。n nAllergen:Allergen:flour,flour,n-amylase,n-amylase,green green coffee,coffee,castor

15、castor and and soy soy beans,beans,spices.spices.egg white,and crustaceans egg white,and crustaceans n n 过过过过敏敏敏敏原原原原：面面面面粉粉粉粉、-淀淀淀淀粉粉粉粉酶酶酶酶、绿绿绿绿咖咖咖咖啡啡啡啡、海海海海狸狸狸狸香香香香和和和和大大大大豆豆豆豆(ddu)(ddu)、调调调调味味味味品品品品、鸡鸡鸡鸡蛋蛋蛋蛋白以及甲壳动物白以及甲壳动物白以及甲壳动物白以及甲壳动物 第18页/共140页第十八页，共140页。Allergic Reactions Following Skin Contac

16、t With Food（四）皮肤（四）皮肤(p f)接触食品接触食品后的过敏反应后的过敏反应 n nAllergen:Allergen:fish,fish,shrimp,shrimp,flour,flour,and and pork pork n n 过过过过 敏敏敏敏 原原原原：鱼鱼鱼鱼、小小小小 虾虾虾虾、面面面面 粉粉粉粉(minfn)(minfn)和猪肉和猪肉和猪肉和猪肉 第19页/共140页第十九页，共140页。n nSymptom Symptom 症状：症状：症状：症状：n n Urticarial lesion Urticarial lesion 风疹风疹风疹风疹n nChron

17、ic contact with a food may induce Chronic contact with a food may induce protein contact,dermatitis in food handlers protein contact,dermatitis in food handlers n n食品操作工人长期接触食品操作工人长期接触食品操作工人长期接触食品操作工人长期接触(jich)(jich)某种食品会某种食品会某种食品会某种食品会诱导蛋白接触诱导蛋白接触诱导蛋白接触诱导蛋白接触(jich)(jich)性皮炎。性皮炎。性皮炎。性皮炎。n n 第20页/共14

18、0页第二十页，共140页。Non-lgE-Mediated Immune Reactions二、不以二、不以IgE为媒介的为媒介的免疫免疫(miny)反应反应 第21页/共140页第二十一页，共140页。Heiners Syndrome,Allergic Alveolitis,and Heiners Syndrome,Allergic Alveolitis,and Hemorrhagic Gastroenteritis in ChildhoodHemorrhagic Gastroenteritis in Childhood（一）儿童（一）儿童（一）儿童（一）儿童(r tng)Heiner(r

19、tng)Heiner综合症、过敏性齿综合症、过敏性齿综合症、过敏性齿综合症、过敏性齿槽炎、出血性肠胃炎槽炎、出血性肠胃炎槽炎、出血性肠胃炎槽炎、出血性肠胃炎 DEFINITIONDEFINITION：The term Heiners The term Heiners syndrome characterizes a syndrome characterizes a milk-induced syndrome with milk-induced syndrome with pulmonary disease in pulmonary disease in infants.infants.Hein

20、erHeiner综合症：婴儿综合症：婴儿(yng r)(yng r)因因牛奶诱导的肺病牛奶诱导的肺病 第22页/共140页第二十二页，共140页。n nSymptom 症状：症状：n nchronic or recurrent pulmonary intiltrates 慢性或周期性发生的肺渗慢性或周期性发生的肺渗透透(shntu)n nallergic alveolitis 过敏性齿槽炎过敏性齿槽炎n na chronic rhinitis 慢性鼻炎慢性鼻炎n ngastrointestinal blood loss 肠胃失血肠胃失血症症n niron deficiency anemia 缺

21、铁性贫血缺铁性贫血n nchronic cough 慢性咳嗽慢性咳嗽n nrecurrent fever 周期性发烧周期性发烧n nAnorexia 厌食厌食n nVomiting 呕吐呕吐n nColic 绞痛绞痛n nDiarrhea 腹泻腹泻n nHemoptysis 咳血咳血第23页/共140页第二十三页，共140页。n nControl Control 控制措施：控制措施：控制措施：控制措施：n ninstitution of a milk-free dietinstitution of a milk-free dietn n饮食饮食饮食饮食(y(y nsh)nsh)中去除牛奶中去除

22、牛奶中去除牛奶中去除牛奶第24页/共140页第二十四页，共140页。Gluten-Sensitive Enteropathy(Celiac Disease)Gluten-Sensitive Enteropathy(Celiac Disease)（二）谷蛋白敏感性肠病（乳糜（二）谷蛋白敏感性肠病（乳糜（二）谷蛋白敏感性肠病（乳糜（二）谷蛋白敏感性肠病（乳糜(r(r m)m)泻）泻）泻）泻）n nDefinitionDefinition：damage damage toto the the small intestinal mucosa small intestinal mucosa and sy

23、mptoms of and symptoms of malabsorptionmalabsorptionn n定义定义(dngy)(dngy)：小肠黏膜损伤：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小肠黏膜损伤和吸收不良症状和吸收不良症状 第25页/共140页第二十五页，共140页。n nAllergen Allergen 过敏原：过敏原：n nGliadin Gliadin 麦醇溶蛋白麦醇溶蛋白n npresent in wheat,rye,present in wheat,rye,barley,and oat barley,and oat n n广泛存在于小麦、燕麦广泛存在于小

24、麦、燕麦(ynmi)(ynmi)、大麦和黑麦中、大麦和黑麦中 第26页/共140页第二十六页，共140页。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(rngy)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。第27页/共140页第二十七页，共140页。n nSymptom Symptom 症状：症状：症状：症状：n nabdominal painabdomi

25、nal pain周期性腹部疼痛周期性腹部疼痛周期性腹部疼痛周期性腹部疼痛n nloose stoolsloose stools便溏便溏便溏便溏n nanorexiaanorexia厌食厌食厌食厌食n nshort statureshort stature体态短小体态短小体态短小体态短小(du(du n xin xi o)o)n ndelayed pubertydelayed puberty青春期滞缓青春期滞缓青春期滞缓青春期滞缓n nnutritional deficienciesnutritional deficiencies吸收不良吸收不良吸收不良吸收不良n nDental enamel

26、hypoplasia Dental enamel hypoplasia 牙科瓷发育不全牙科瓷发育不全牙科瓷发育不全牙科瓷发育不全n nrecurrent aphthaerecurrent aphthae周期性口疮周期性口疮周期性口疮周期性口疮 第28页/共140页第二十八页，共140页。n nControl 控制措施：控制措施：n nPatients with celiac disease must avoid gliadins and related proteins permanentlyn n远离麦醇溶蛋白以及远离麦醇溶蛋白以及(yj)相关蛋相关蛋白质白质第29页/共140页第二十九页，

27、共140页。Dermatitis Herpetiformis Dermatitis Herpetiformis（三）疱疹（三）疱疹(po zhn)(po zhn)样皮炎样皮炎 n nDefinition 定义(dngy)：n n chronic blistering diseasen n 一种慢性起疱疾病 第30页/共140页第三十页，共140页。n n Symptom Symptom 症状：症状：症状：症状：n nitchy itchy 发痒发痒发痒发痒n nsometimes burning sometimes burning 有时有灼伤感有时有灼伤感有时有灼伤感有时有灼伤感n nerup

28、tion of grouped vesicles on an eruption of grouped vesicles on an erythematous ground erythematous ground 在红斑状范围在红斑状范围在红斑状范围在红斑状范围(fnwi)(fnwi)内出现成群泡样出疹内出现成群泡样出疹内出现成群泡样出疹内出现成群泡样出疹 第31页/共140页第三十一页，共140页。n nSome DH patients,even without gastrointestinal symptoms,may have villous atrophy similar to that

29、 seen in celiac diseasen n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(rm)泻类似的绒毛状萎缩症，也就是说DH与CD之间有关连。n nThe cutaneous manifestations may or may not respond to a gluten-free dietn n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。第32页/共140页第三十二页，共140页。Eosinophilic Gastroenteritis Eosinophilic Gastroenteritis Eosinophilic Gastroenteriti

30、s Eosinophilic Gastroenteritis（四）嗜酸性（四）嗜酸性（四）嗜酸性（四）嗜酸性(sun xn)(sun xn)(sun xn)(sun xn)胃肠炎胃肠炎胃肠炎胃肠炎n nDefinition Definition Definition Definition 定义：定义：定义：定义：n nelevated eosinophil counts in blood and elevated eosinophil counts in blood and elevated eosinophil counts in blood and elevated eosinophil

31、counts in blood and tissue eosinophilia with release of tissue eosinophilia with release of tissue eosinophilia with release of tissue eosinophilia with release of eosinophii major basic protein eosinophii major basic protein eosinophii major basic protein eosinophii major basic protein n n释放释放释放释放(

32、shfng)(shfng)(shfng)(shfng)嗜曙红细胞主要基本蛋白质后，嗜曙红细胞主要基本蛋白质后，嗜曙红细胞主要基本蛋白质后，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血液中嗜曙红细胞和嗜曙红血球增多的间质组血液中嗜曙红细胞和嗜曙红血球增多的间质组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织内嗜曙红细胞计数值升高织内嗜曙红细胞计数值升高织内嗜曙红细胞计数值升高 第33页/共140页第三十三页，共140页。n n Clinical manifestations 临床症状：n n vomiting 呕吐n nabdominal pain

33、腹部疼痛n nDiarrhea 腹泻n n malabsorption 吸收不良(bling)n nbowel obstruction 肠阻塞n nAscites 腹水第34页/共140页第三十四页，共140页。n nThe cause of EG is unknownn n 起因还不清楚n nfood hypersensitivity has been suggestedn n EG可能由食品(shpn)超敏性引起第35页/共140页第三十五页，共140页。Utcerative Colitis（五）溃疡性结肠炎（五）溃疡性结肠炎n nDefinition 定义：n n an inflamma

34、tory bowel disease of unknown originn n 一种(y zhn)不明起因的炎症性肠病 第36页/共140页第三十六页，共140页。n nNo adverse food reactions have been shown as causative of UC n n还不能证明(zhngmng)食品不良反应会造成UC 第37页/共140页第三十七页，共140页。Allergic Vasculitis（六）（六）变应性脉管炎变应性脉管炎 n nCause Cause Cause Cause 起因起因起因起因(qyn)(qyn)(qyn)(qyn)：n nfoods

35、and food additivesfoods and food additivesfoods and food additivesfoods and food additivesn n 食品及其添加剂食品及其添加剂食品及其添加剂食品及其添加剂第38页/共140页第三十八页，共140页。n nSymptom Symptom Symptom Symptom 症状：症状：症状：症状：n nallergic purpura(widespread allergic purpura(widespread allergic purpura(widespread allergic purpura(wides

36、pread hemorrhagic macules and papules,hemorrhagic macules and papules,hemorrhagic macules and papules,hemorrhagic macules and papules,mainly on the lower legs)mainly on the lower legs)mainly on the lower legs)mainly on the lower legs)demonstrated by single challengesdemonstrated by single challenges

37、demonstrated by single challengesdemonstrated by single challengesn n变应性紫癜变应性紫癜变应性紫癜变应性紫癜(z din)(z din)(z din)(z din)（分布广泛的出血（分布广泛的出血（分布广泛的出血（分布广泛的出血性斑丘疹，主要出现在腿的下部）性斑丘疹，主要出现在腿的下部）性斑丘疹，主要出现在腿的下部）性斑丘疹，主要出现在腿的下部）第39页/共140页第三十九页，共140页。Food Intolerance三、食品三、食品(shpn)不耐不耐性性 第40页/共140页第四十页，共140页。Lactase Def

38、iciency乳糖酶缺乏乳糖酶缺乏(quf)综合征综合征 n nDefinition Definition 定义：定义：定义：定义：n nLack of the enzyme that cleaves milk Lack of the enzyme that cleaves milk sugar,lactose,gives rise sugar,lactose,gives rise toto adverse adverse reactions when lactose is consumed.reactions when lactose is consumed.n n当摄入乳糖当摄入乳糖当摄入

39、乳糖当摄入乳糖(r(r tn tn)时，由于体内缺乏时，由于体内缺乏时，由于体内缺乏时，由于体内缺乏一种能将牛奶糖质一种能将牛奶糖质一种能将牛奶糖质一种能将牛奶糖质-乳糖乳糖乳糖乳糖(r(r tn tn)水解水解水解水解的酶，从而产生不良反应的酶，从而产生不良反应的酶，从而产生不良反应的酶，从而产生不良反应 第41页/共140页第四十一页，共140页。n nThe only food of which lactose is a natural constituent is milk(3.7 g/100 ml cows milk).n n 天然含乳糖的唯一食品(shpn)是牛奶（3.7g/ml牛

40、奶）第42页/共140页第四十二页，共140页。n nClassification Classification 分类：分类：分类：分类：n n1 1）congenital lactase deficiency congenital lactase deficiency先天性乳先天性乳先天性乳先天性乳糖酶缺乏糖酶缺乏糖酶缺乏糖酶缺乏(quf)(quf)综合征综合征综合征综合征n n2 2）primary lactase deficiency primary lactase deficiency初级的乳糖初级的乳糖初级的乳糖初级的乳糖酶缺乏酶缺乏酶缺乏酶缺乏(quf)(quf)综合征综合征综合征

41、综合征n n3 3）secondary lactase deficiency secondary lactase deficiency二级乳糖二级乳糖二级乳糖二级乳糖酶缺乏酶缺乏酶缺乏酶缺乏(quf)(quf)综合征综合征综合征综合征 第43页/共140页第四十三页，共140页。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(sh hu)出现综合征The cong

42、enital form is very rare 这种症状极少见第44页/共140页第四十四页，共140页。2）primary lactase deficiency初级的乳糖酶缺乏综合征seen in most of the worlds 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(xijing)或消失第45页/共140页第四十五页，共140页。n n Persistent Persistent h

43、igh high lactase lactase activity activity in in adult adult life life occurs occurs among among relatively relatively few few ethnic ethnic groups:groups:n n成年人体内乳糖酶活性一直处于高峰的人群：成年人体内乳糖酶活性一直处于高峰的人群：n nnorthern northern Europeans Europeans and and their their overseas overseas descendantsdescendants北

44、欧以及沿海北欧以及沿海(ynhi)(ynhi)后代后代n na a few few African African groups groups of of pastoral pastoral tradition tradition Bedouins Bedouins and and other other Saudi Saudi ArabsArabs一一些些源源于于牧牧人人的的非非洲人、贝都因人和沙特阿拉伯人洲人、贝都因人和沙特阿拉伯人n n certain certain groups groups from from west west India India and and Pakist

45、anPakistan西西印度和巴基斯坦部分人群印度和巴基斯坦部分人群第46页/共140页第四十六页，共140页。n n3 3）secondary lactase deficiency secondary lactase deficiency二级乳二级乳糖酶缺乏综合征糖酶缺乏综合征n na consequence of pathological changes a consequence of pathological changes in the gut mucosa,as seen in celiac in the gut mucosa,as seen in celiac disease o

46、r inflammations.disease or inflammations.n n 乳糜泻或炎症引起乳糜泻或炎症引起(ynq)(ynq)内脏黏膜病变的内脏黏膜病变的结果结果n n n nWhen the gut mucosa has regained its When the gut mucosa has regained its normal appearance the lactase normal appearance the lactase production reappearsproduction reappearsn n 当内脏黏膜恢复正常，乳糖酶也开始重新当内脏黏膜恢复正

47、常，乳糖酶也开始重新分泌。分泌。第47页/共140页第四十七页，共140页。n nThe symptoms The symptoms The symptoms The symptoms 症状：症状：症状：症状：n nDiarrhea Diarrhea Diarrhea Diarrhea 腹泻腹泻腹泻腹泻(fxi)(fxi)(fxi)(fxi)n ngas production gas production gas production gas production 产气产气产气产气n nColic Colic Colic Colic 绞痛绞痛绞痛绞痛第48页/共140页第四十八页，共140页。

48、n nControl 控制措施：n navoid all products containing even small amounts of lactosen n 避免食用任何(rnh)含乳糖的食品 第49页/共140页第四十九页，共140页。PREVALENCEPREVALENCE第四节第四节 发病率发病率 第50页/共140页第五十页，共140页。n nThe The total total prevalence prevalence of of food food allergy/food allergy/food intolerance intolerance is is not no

49、t known.known.n n 总发病率未知总发病率未知n nEstimates Estimates based based on on data data from from one one country country do do not not necessarily necessarily reflect the prevalence of another countryreflect the prevalence of another countryn n 在在某某个个国国家家统统计计(t(t ngj)ngj)得得到到的的数数据据并并不不能能用用到到另另一一个个国国家，因为：家

50、，因为：n n1 1）frequency and duration of breast feeding frequency and duration of breast feedingn n 母乳喂养的频率和持续时间母乳喂养的频率和持续时间n n2 2）eating habitseating habits饮食习惯饮食习惯n n3 3）flora flora植物群植物群第51页/共140页第五十一页，共140页。Children一、儿童一、儿童(r tng)第52页/共140页第五十二页，共140页。Food（一）食品（一）食品(shpn)n nallergy allergy toto cows