15. FOOD ALLERGY.ppt
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Transcript of 15. FOOD ALLERGY.ppt
FOOD ALLERGY
By
NURPUDJI ASTUTI
SCHOOL OF MEDICINEHASANUDDIN UNIVERSITY
MAKASSAR 2003
WHAT IS FOOD ALLERGY
Is a response of the immune system to a component of food, almost invariably a protein
OrA molecule linked to a protein, that the immune system recognizes as a foreign to the body
OrFOOD HYPERSENSITIVITY
IMUNOLOGICAL MECHANISMS OF ALLERGY
HYPERSENSITIVITY REACTIONS INVOLVE A SERIES OF SPECIFIC EVENTS AND RESULT IN CLINICAL SYMPTOMS.
EACH TYPE INVOLVES DIFFERENT COMPONENTS OF IMMUNE SYSTEM.
FOOD ALLERGY CAN BE MEDIATED BY Type I, Type III OR TYPE IV HYPERSENSITIVITY OR POSSIBLY BY COMBINATION OF THIS TYPES.
FOOD ALLERGY
IS COMMON IN INFANCY PREVALENCE 1 – 3% ONLY REPRESENTS A SMALL
PROPORTION OF FOOD REACTION IN THE ADULT.
SOMETIMES FOOD ALLERGY IS LIFELONG
TYPE I HYPERSENSITIVITY
INVOLVES IgE ANTIBODIES MAST CELLS OTHER GRANULOCYTES
SYMPTOMS ATOPY PERSON MUST BE SENSITIZED BY A FIRST EXPOSURE
TO THE ALLERGEN
SENSITIZATION B-CELL LYMPHOCYTES PRODUCE ALLERGEN SPECIFIC
IgE ANTIBODIES IgE MOLECULES COUPLE WITH RECEPTORS ON THE
SURFACE OF MAST CELLS ( IN TISSUES) AND BASOPHYL ( IN BLOOD)
NO SYMPTOMS ARE OBSERVED ON FIRST EXPOSURE TO THE ALLERGEN
TYPE III HYPERSENSITIVITY
INVOLVES IgM AND IgG CHEMICALS FORMED IN THE COMPLEMENT CASCADE STEP REACTION ARE:
T-cell lymphocytes recognize the antigen as foreign after it is processed by macrophages
IgM and later IgG are produced in response to the antigen
Ag-Ab complexes are formed The complement cascade is triggered Anaphylatoxins formed in the complement
cascade cause the release of inflammatory mediators
TYPE IV HYPERSENSITIVITY
T cell lymphocytes and cytokines Called as contact allergy T-cells lymphocytes respond to the
allergen - release of cytokine. An immediate reaction when thry come
into contact with the lips, tongue, mouth and GIT.
Example: Nickel allergy
Allergy as an Inflammatory Process
Symptoms of allergy result from the release of inflamatory mediators
Histamin – increases the permeability of capillaries – swelling
Rhinitis – is due to fluid buildup in tissues in nasal passages
Excessive fluid in the skin causes urticaria (hives) and angioedema
Histamin also causes itching and vasodelation, resulting in flushing or reddening of the skin
Continue ----
Allergy as an Inflammatory Process Prostaglandins caused vasodelation and
vasocontriction
Leukotrienes - contraction of smooth muscle – bronhospasm of asthma
Bradykinin in conjunction with prostaglandins causes pain.
Sometimes these inflammatory mediators are released or their levels are enchanced by mechanisms that are independent of the immune system – this situation considered to be INTOLERANCE rather than ALLERGY
INCIDENCE OF ALLERGY
5 – 15 % if neither parent has allergies 20 – 40% if one parent has allergies 40 – 60% if both parents have allergies 60 – 80% if both parents have the same
allergy 25 -35% if one sibling has allergies
FACTOR CONTRIBUTING TO THE EXPRESSION OF ALLERGY TO FOODS
INHERITED PHYSIOLOGICAL CONDITIONS
1. INCREASED PERMEABILITY OF THE INTESTINAL MUCOSA
2. IMMATURITY
3. INFLAMMATION IN THE DIGESTIVE TRACT
4. COMBINED ALLERGIC REACTIONS
5. ENCHANCES UPTAKE OF FOOD ALLERGENS
6. EXERCISE
7. CHANGES IN HORMONE LEVEL
8. STRESS
9. FREQUENCY OF EXPOSURE
ADVERSE REACTION TO FOOD ADDITIVES
FOOD ADDITIVES;
any substance, including any source of radiation, the used of which results, or may reasonably be expected to result, in it or its by products becoming a part of or affecting the characteristics of food
PRESERVATIVES AS COLORING AGENT ( to provide taste, odor, and texture )
Dyes such as tartrazine, erythrosine Preservatives such as: sulfites, benzoates, sorbates Flavoring agents and flavor enchancers;
monosodium glutamate (MSG) Ripening agents; ethylene Antioxidants; butylated hydroxyanisole (BHA) ,
butylated hydroxytoluene (BHT), sodium nitrite Emulsifiers, lecithin, polysorbate Texturizers; calcium chloride, Humectants; glycerine, propylene glycol Thickeners & stabilizers; gum tragacanth, agar-agar
SOURCE OF FOOD ADDITIVES
CHEMICAL ADDITIVES --- USED EXTENSIVELY IN MANUFACTURED FOODS
PROBLEMS FOR PERSONS WITH FOOD SENSITIVITIES CHEMICALS; DIVERSE IN COMPOSITION AND TYPES DERIVED FROM NATURAL SOURCES ( CHEMICAL
PROCESSES) & SYNTHESIZED FROM INORGANIC SOURCES.
??? ---- VERY LITTLE UNDERSTANDING OF HOW THE CHEMICAL CAUSES THE ADVERSE CLINICAL EFFECTS
CLINICAL REACTIONS TO FOOD ADDITIVES
Urticaria Angioedema Asthma Rhinitis Headache Irritable bowel syndrome
clinical reaction continues -----
HYPERACTIVITYFOOD COLORSPRESERVATIVESMANY FOODS
SENSITIVITY TO MONO SODIUM GLUTAMATESYMPTOMS RESEMBLE TO MYOCARDIAL INFARCTION, INCLUDING TIGHTNESS AND PAIN IN THE CHEST WHICH RADIATES TO THE ARMS, PALPITATIONS AND FAINTNESS.
IDENTIFYING SENSITIVITY TO FOOD ADDITIVES
SAIFER AND SAIFER
USED ANECDOTAL MARKERS, ONE OF THE SIGNS IS DEVELOPMENT OF SENSITIVITY TO ALCOHOL, STARTING WITH ADVERSE REACTIONS TO RED WINE & BEER, AND FOLLOWED BY WHITE WINE AND DESTILLED SPIRITS.
SENSITIVITY TO INGESTED CHEMICALS, SUCH AS GASOLINE, CIGARETTE SMOKE, PAINT SOLVENTS, HOUSE-HOLD CLEANERS
INDICATORS OF CHEMICAL FOOD ADDITIVE INTOLERANCE ARE MULTISYSTEM RAECTIONS, ESPECIALLY CENTRAL NERVUS SYSTEM SUCH AS: HEADACHE, FATIGUE, MUSCLE WEAKNESS, SKIN AND RESPIRATORY SYMPTOMS.
AT PRESENT, THE ONLY INDICATOR OF FOOD ADDITIVES INTOLERANCE IN MOST CASES IS ELEMINATION AND CHALLENGE WITH FOODS CONTAINING THE SUSPECTED ADDITIVE(S)
FOOD ADDITIVES MOST FREQUENTLY IMPLICATED IN ADVERSE REACTIONS
TARTRAZINE AND OTHERS FOOD DYES SULFITES NITRATES AND NITRITES BENZOATS SORBATES BUTYLATED HYDROXYANISOLE (BHA) BUTYLATED HYDROXYTOLUENE (BHT) SALICYLATES MONOSODIUM GLUTAMATE AND OTHER
GLUTAMATES
ANAPHYLACTIC REACTIONS TO FOODS
Occurrence of Anaphylactic reactions to foods
Person with asthmatic -- more likely than general population
Increased when the person is receiving desensitization injections or is allergic to wasp and bee venom
Most commonly food are ” peanuts, nuts, shellfish, fish, cow’s milk, and egg”
Most study --- 80% of atopic children are allergic to only one or two foods.
Continues ---
Anaphylactic reaction to cow’s milk, egg, wheat and chicken in children under three year of age
Infant and toddlers tend to outgrow early allergies to certain foods, such as milk, egg, wheat and soy
Food allergy occurs after 3 yo, the allergy is likely to be outgrown.
Allergies to certain other foods – to be outgrown or may persist for a person’s lifetime --- such as: peanuts, nut, shellfish and fish.
Foods implicated in anaphylactic reactions
NUTS
PeanutsPecanPistachioCashewBrazilpinom
Seeds
MilletSubflowerSesameCottonseed extractAnnatto ( color )Psyllum
Grains
WheatRice
Continues --
Vegetables Potato Celery Pea Pinto bean Soybean Chickpea Corn
Fruit orange Tangerine Mango Banana Kiwi fruit
Poultry chicken
EggHen
Fish Cod Halibut
Beverages Chamomile tea wine
Shellfish crab Shrimp Lobster Limpet
Milk products cow’s milk
ALLERGENIC CROSS-REACTIVITY BETWEEN BOTANICALLY RELATED PLANTS
CROSS REACTIVITY DEFINED AS A CONNECTION BETWEEN TWO OR MORE ALLERGENS, WHEATHER RELATED OR NOT, THAT CAUSES OF THEM TO INDUCE SIMILAR CLINICAL REACTIONS
NOT VALID PLANTS BELONG TO THE SAME FAMILY, THEY ARE NECESSSARILY RELATED ANTIGENECALLY
ALLERGIC REACTION TO A SINGLE SPECIES DOES NOT AUTOMATICALLY LEAD TO ALL MEMBERS OT THAT PLANT FAMILY
ALLERGENIC CROSS-REACTIVITY BETWEEN UNRELATED PLANT SPECIES
RECENT STUDY HAS DEMONSTRATED THE PRESENCE OF CROSS REACTING ANTIGRNS IN BOTANICALLY UNRELATED, ALLERGENIC PLANT SPECIES.
THE ALLERGENS MAY BE INHALED OR CONSUMED AS FOOD
COMMON ANTIGENS HAVE BEEN DEMONSTRATED WITHIN EACH OF THE FOLLOWING GROUPINGS:
1. BIRCH POLLEN, HAZELNUT, POTATO AND APPLE 2. APPLE, CARROT AND CELERY 3. BIRCH POLLEN, NUT, APPLE AND FRUIT WITH STONE 4. HAZELNUT, RYE GRAIN, SESAME SEEDS, KIWI, AND POPPY SEED 5. BIRCH POLLEN, MUGWORT POLLEN, APPLE, CELERY AND CARROT 6. BIRCH POLLEN, APPLE, CELERY, CARROT, POTATO, HAZELNUT, ORANGE, TOMATO AND PEANUT 7. REGWEED POLLEN AND WATERMELON 8. REGWEED POLLEN, MELON AND BANANA 9. LATEX, BANANA, AVOCADO, KIWI FRUIT, CHESTNUT, SOYBEAN, PEANUT, PAPAYA, FIG.
Continues ---- FOOD ALLERGY
Lesson two
THURSDAY, OCTOBER 16TH, 2003
Nurpudji AstutiNutrition Department School of Medicine
Hasanuddin University
ALLERGENIC POTENTIAL FOOD
TO WHAT EXTENT SHOULD A KNOWN ALLERGEN BE AVOIDED ???example: person allergic to soy, should all form of soy be eliminated from the diet, including hydrolyzed soy protein, lecithin made from soy, fermented soy ( soy sauce) and so on??
FOR SAFETY, THE ALLERGIC PERSON IS USUALLY ADVISED TO AVOID ALL FORMS OF THE FOOD.
IMPACT: great deal of work social economy stress annoyance nutritional deficiency fearful of ingesting the allergen --- fail to describe of
ingredients in manufactured foods.
DEGREE OF INDIVIDUAL REACTS
Depends on a number of factors, including the allergenic potency of the food.
Mildly allergic to food --- fewer precautions need be taken in detecting the food as hidden ingredient.
Avoid all --- allergic food precipitate a life threatening anaphylactic reaction.
FOODS MOST LIKELY TO CAUSE A SEVERE REACTION IN THE HYPERSENSITIVE PERSON
Peanuts
Green peas
Tree nut
Shellfish
Finfish
Egg white
Cow’s milk protein in infants
QUANTITY OF FOOD REQUIRED TO CAUSE AN ALLERGIC REACTION
Depend on the potency of the allergen The allergic person’s response
Sensitized adult is 20 grams Shrimp allergy will provoked with 1-2 grams of
shrimp Peanuts allergy can be precipitated by as little as
25 mg of peanut. Inhaling food component or handling can
precipitate a reaction in highly sensitive individual
Food additives derived from potentially allergenic foods
Name Source Foods likely to contain the additive
Function of foods
Lecithin
Annatto
EggEgg yolkSoy beanCorn
Extract from the seed of tropical tree
Boxed breakfast cerealCandyChocolatesBreads, rolls, burnsMargarine
Dairy products (cheese, butter)Breakfast cerealBaked goodsmargarines
Antioxidant and emollient composed of choline, phosphoric acid, fatty acids and glycerin
Coloring agent ( yellow to pink)
MILK ALLERGY BIOLOGICAL MECHANISMS
Results when the immune system produces antibodies against milk allergen
The allergenicity test using skin test and oral challenges Casein protein produced the highest # of positive skin tests in
children with milk allergy Children or adults react more than one milk protein
HEAT LABILE Serum protein and beta casein
THE MOST HEAT LABILE Beta - lactoglobulin Alpha - lactalbumin
ANTIBODIES produced against milk proteins may: IgE, IgM, IgG, sometimes IgA
MANAGEMENT OF MILK ALLERGY
Elimination dietary milk Foods containing milk Product from milk Liquid and evaporated milk Fermented milks (yogurt, buttermilk) Cream All cheeses Ice cream Ice milk
Food substitutes Milk provide:
protein, calcium and vitamin D
Protein substitute Readily available from fish, mat or
combinations of legumes, nut, grains Adequate dietary protein does not depend on
ingesting milk
Calcium substitute Canned fish such as tuna , sardines, salmon
eaten with the bones Green leafy vegetable: broccoli, beet, turnip Calcium from vegetable is not as readily
available as from animal sources
SUBSTITUTES IN MEALS AND RECIPES
Soy milk Mocha mix Rice dream ( brown rice = safflower oil ) Coconut milk Nut milk Whey- free margarine Non-diary creamers (vegetable oil products) Soy Bean curd or Cake (Tofu)
LACTOSA INTOLERANCE
Not involve a response by the immune system
No antibodies are produced
Enzyme lactase is insufficient to break down the quantity of lactose
consumed at any one time
Lactase produced by the brush border cells of the small intestine ---
damaged --- inflammation (infection or allergy) --- or congenital
characteristic, the sugar remain undigested – microbial enzymes
metabolize lactose –variety organic acid (lactic and propionic acids),
gases (hydrogen)– imbalance result from the exceed sugar and acid ---
water is drawn to correct the problem---- DIARRHEA
Symptoms are pain, bloating and gas due to bacterial fermentation of lactose
INCIDENCE OF LACTASE DEFICIENCY
Asian, Black African races, people from mediterranean region, lose of the ability to produce lactase
Starting five year of age Prevalence about 80% 20% of North European origin lose ability to produce lactase Lactase deficiency uncommon in infants---lactose is principal
sugar in human milk and infants require lactase to digest their mother’s milk.
Secondary lactase deficiency can develop in infant following a bacterial and viral infection of digestive tract--- diarrhea
Infant unable to tolerate lactose until the infection subsides and the intestinal mucosa recovers.
TREATMENT
COMPLETE DIETARY EXCLUSION OF COW’S MILK
70 -80% ALLERGIC TO COW’S ARE ALSO ALLERGIC TO GOAT’S MILK PROTEINS
MILK SUBSTITUTE IS USUALLY NECESSARY
Peanut allergy Peanuts are legumes
Peanuts and soy the most allergenic of the family leguminosae – 30 species – including fresh or dried peas and beans, all type lentils, soy beans, carob and licorice.
Symptomatic reactivity to more than one member of the legume family is rare
Reaction to peanut, soy, and other legume are managed separate allergies.
Peanuts are the most frequently cited causes of life threatening anaphylactic reactions
Once a person had had an anaphylactic reaction to peanuts, extreme caution must be exercised to avoid all sources of peanut
An allergy to nuts should be distinguished from an allergy to peanuts or other legumes, otherwise the diet can become stressful and cumbersome if all traces of peanuts are avoided, as well as all traces of other nuts.
Warning !!!!!!!!! Sometimes no differentiation is made in marketing
peanuts and other nuts, and the two are sold together in “ nut mixtures”.
In the manufacture of candies, confectioneries and ice creams, cross contamination occurs between nuts and peanuts.
Result – persons with severe peanut allergy should be advised to avoid any product containing any type of “NUT” because the danger of encountering peanuts inadvertently.
Symptoms of Peanut Allergy“the allergy is considered to be lifelong”
Urticaria Angioedema Wheezing Asthma Vomiting Rhinorrhea Itching --- contact dermatitis Nausea Allergic conjunctivitis anaphylaxis
Studies have indicated that peanuts allergic adult can tolerate pure peanut oil without any clinical reactions.
The allergic reactivity occurs to the protein not to the oil
However, because traces of the protein may contaminate the oil, individuals who are anaphylactic to peanut, or to any another plant, should be cautioned to avoid oil derived from allergenic plant.
EGG ALLERGY Mayor proteins for egg allergy present in egg white
OvalbuminConalbumin ( ovotransferrin )Ovomucoid
Yellow egg present as livetins derived from the blood of the hen
Cross reactivity may occur between white and yellow egg
Ovomucoid is heat stable, persons allergic to this component react to both cooked and raw egg
Ige Antibodies are produces to egg proteins, which differ from the protein in chicken flesh
FOODS CONTAINING EGGS AVOIDANCE OF EGGS AS AN INDIVIDUAL FOOD IN A
MEAL
SCRAMBLED, BOILED, FRIED OR
OMELETE EGGS INCLUDED AS AN INGREDIENT IN PREPARED
FOOD, MAY NOT BE EASILY RECOGNIZED
BOYH PRACTITIONER AND ALLERGY SUFFERER
NEED TO BE AWAREOF THE FOODS
TRADITIONALLY MADE WITH EGGS.
PROTEIN COMPOSITION OF EGGS
56 -61% OF THE WEIGHT OF CHICKEN EGGS IS THE WHITE
27 -32% IS YOLK
THE REST IS SHELL
EGG WHITE PROTEINS
OVALBUMIN
CONALBUMIN
OVOMUCOID
OVOMUCIN
LYSOZYME
EGG YOLK PROTEINS
LIPOVITELLIN
PHOSVITIN
LOW DENSITY LIPOPROTEINS
LIVERTONS
TRACE AMOUNTS OF OTHER PROTEINS
CATALASE OVOFLAVOPROTEIN FICIN INHIBITOR OVOGLYCOPROTEIN G2 AND G3 GLOBULINS OVOMACROGLOBULIN RIBONUCLEASE OVOINHIBITOR AVIDIN