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Trends in Allergies andTrends in Allergies and
Intolerances in Nutrition andIntolerances in Nutrition and
Food ServiceFood Service
Dr. HarishDr. Harish KakraniKakrani
CDCPCDCP
&&PurviPurvi KakraniKakrani
ARCPARCP
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Progress in the Past 5 YearsProgress in the Past 5 Years
Nearly 4% of North Americans have food allergies, manyNearly 4% of North Americans have food allergies, manymore than recorded in the pastmore than recorded in the past
Incidence of food allergy much higher in children than adultsIncidence of food allergy much higher in children than adults(>8% compared to 8% compared to
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Management of Food Allergies and IntolerancesManagement of Food Allergies and Intolerances
Management of food sensitivities consists of:Management of food sensitivities consists of:
Accurate identification of the food causing theAccurate identification of the food causing theproblemproblem
Educating clients on how to avoid relevantEducating clients on how to avoid relevantallergens and intolerance triggers in foodsallergens and intolerance triggers in foods
Formulating appropriate diets to avoid the culpritFormulating appropriate diets to avoid the culpritfoods and replacing them with foods of equivalentfoods and replacing them with foods of equivalent
nutritional valuenutritional value Educating parents in measures to avoidEducating parents in measures to avoid
sensitization of their atsensitization of their at--risk babiesrisk babies
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The Allergic DiathesisThe Allergic Diathesis
..
Food Allergy
Atopic dermatitis
(Eczema)
Allergic
rhinoconjunctivitis
(hay fever)
Asthma
(cough;
wheeze)
Gastrointestinal
symptoms
Sleep deprivation
Anaphylaxis
Mental fogginess
Irritability
Fatigue
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Food AllergyFood Allergy
Response of theResponse of the
Immune SystemImmune System
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Priority Food Allergens In CanadaPriority Food Allergens In Canada
PeanutsPeanutsTree nuts (almonds, Brazil nuts, cashews, hazelnutsTree nuts (almonds, Brazil nuts, cashews, hazelnuts(filberts), macadamia nuts, pecans,(filberts), macadamia nuts, pecans, pinenutspinenuts, pistachios,, pistachios,walnuts)walnuts)
Sesame seedsSesame seeds
MilkMilkEggsEggs
FishFish
Shellfish (e.g. clams, mussels, oysters, scallops andShellfish (e.g. clams, mussels, oysters, scallops andcrustaceans (e.g. crab, crayfish, lobster, shrimp) )crustaceans (e.g. crab, crayfish, lobster, shrimp) )
SoySoyWheatWheat
SulphitesSulphites
These Priority Allergens account for more than 95% ofThese Priority Allergens account for more than 95% ofsevere adverse reactions related to food allergenssevere adverse reactions related to food allergens
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Additional Factors Involved in SymptomsAdditional Factors Involved in Symptoms
of Food Sensitivityof Food Sensitivity
Increased permeability of the digestive tractIncreased permeability of the digestive tract
(leaky gut)(leaky gut)
Inflammation:Inflammation:
InfectionInfectionAllergyAllergy
Autoimmune diseaseAutoimmune disease
Other diseasesOther diseases
Immaturity (in infants)Immaturity (in infants) Alcohol consumptionAlcohol consumption
Physical exertion:Physical exertion:
ExerciseExercise--induced anaphylaxisinduced anaphylaxisPurvi Kakrani & Dr. Harish KakraniPurvi Kakrani & Dr. Harish Kakrani
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Additional Factors Involved inAdditional Factors Involved in
Symptoms of Food SensitivitySymptoms of Food Sensitivity
StressStress
Eating several different allergenic foods at theEating several different allergenic foods at thesame timesame time
Other allergies occurring at the same timeOther allergies occurring at the same time(e.g. hay fever, asthma)(e.g. hay fever, asthma)
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Classification of Food AllergensClassification of Food Allergens
[Sampson 2003]:[Sampson 2003]:
Class 1:Class 1: Direct sensitization via the gastrointestinal tractDirect sensitization via the gastrointestinal tract
after ingestionafter ingestion
WaterWater--soluble proteins or glycoproteinssoluble proteins or glycoproteins Stable to heat, proteases, and acidStable to heat, proteases, and acid
Many are lipid transfer proteinsMany are lipid transfer proteins
Class 2:Class 2: Sensitization by inhalation of airSensitization by inhalation of air--borne allergenborne allergen
CrossCross--reaction to foods containing structurallyreaction to foods containing structurallyidentical proteinsidentical proteins
Heat labileHeat labile
Many are pathogenesisMany are pathogenesis--related proteinsrelated proteins
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Oral Allergy SyndromeOral Allergy Syndrome
(OAS)(OAS)OAS refers to clinical symptoms in theOAS refers to clinical symptoms in themucosa of the mouth and throat that:mucosa of the mouth and throat that:
Result from direct contact with a food allergenResult from direct contact with a food allergenIn an individual who also exhibits allergy toIn an individual who also exhibits allergy toinhaled allergens.inhaled allergens.
Usually pollens (pollinosis) are the primaryUsually pollens (pollinosis) are the primary
allergensallergensPollens usually trigger rhinitis or asthmaPollens usually trigger rhinitis or asthma
Occurs most frequently in adultsOccurs most frequently in adults
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Oral Allergy SyndromeOral Allergy Syndrome
The foods cause symptoms in the oral cavityThe foods cause symptoms in the oral cavity
and local tissues immediately on contact:and local tissues immediately on contact:
SwellingSwelling
Throat tighteningThroat tightening
TinglingTingling
ItchingItching
BlisteringBlisteringFoods most frequently associated with OASFoods most frequently associated with OAS
are mainly fruits, a few vegetables, and nutsare mainly fruits, a few vegetables, and nuts
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Oral Allergy SyndromeOral Allergy Syndrome
AllergensAllergens
Pollens and foods that cause OAS are usuallyPollens and foods that cause OAS are usuallybotanically unrelatedbotanically unrelated
Occurs most frequently in persons allergic to birchOccurs most frequently in persons allergic to birchand alder pollensand alder pollens
Also occurs with allergy to:Also occurs with allergy to:
Ragweed pollenRagweed pollen
Mugwort pollenMugwort pollen
Grass pollensGrass pollens
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Oral Allergy SyndromeOral Allergy SyndromeCrossCross--reacting allergensreacting allergens
Birch pollens with:Birch pollens with:
AppleApple
Stone Fruits (Apricot, Peach, Nectarine, Plum, Cherry)Stone Fruits (Apricot, Peach, Nectarine, Plum, Cherry)
Kiwi FruitKiwi Fruit OrangeOrange -- PeanutPeanut -- AlmondAlmond
MelonMelon -- HazelnutHazelnut -- WalnutWalnut
WatermelonWatermelon -- CarrotCarrot -- AniseAnise
PotatoPotato -- CeleryCelery -- Caraway seedCaraway seed
TomatoTomato -- ParsnipParsnip
Green pepperGreen pepper -- ParsleyParsley CuminCumin -- BeansBeans
CorianderCoriander -- PeasPeas
DillDill -- LentilsLentils Sunflower seedSunflower seed -- SoySoy
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Oral Allergy SyndromeOral Allergy Syndrome
CrossCross--reacting allergensreacting allergensRagweed pollen with:Ragweed pollen with:
BananaBanana
CantaloupeCantaloupe HoneydewHoneydew
WatermelonWatermelon
Other MelonsOther Melons
Zucchini (Courgette)Zucchini (Courgette)
CucumberCucumber
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Expression of OAS SymptomsExpression of OAS Symptoms
Oral reactivity to the food significantlyOral reactivity to the food significantlydecreases when food is cookeddecreases when food is cooked
Reactivity of the antigen depends onReactivity of the antigen depends onripenessripeness
Antigen becomes more potent as the plantAntigen becomes more potent as the plantmaterial agesmaterial ages
People differ in the foods which triggerPeople differ in the foods which triggerOAS, even when they are allergic to theOAS, even when they are allergic to the
crosscross--reacting pollensreacting pollens Foods contain an antigen that is structurallyFoods contain an antigen that is structurally
similar to the allergenic pollen, but not allsimilar to the allergenic pollen, but not allpeople will develop OAS to all foods having thatpeople will develop OAS to all foods having thatantigenantigen
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Identification of Foods ResponsibleIdentification of Foods Responsible
for OAS Symptomsfor OAS Symptoms
Skin tests will identify the allergenic plant pollenSkin tests will identify the allergenic plant pollen
Skin testing has not been successful inSkin testing has not been successful inidentifying persons who react to crossidentifying persons who react to cross--reactingreacting
food antigensfood antigens Plant antigens are unstable and do not survive thePlant antigens are unstable and do not survive the
process of antigen preparationprocess of antigen preparation
Crushing plant material leads to release of phenolsCrushing plant material leads to release of phenolsand degradative enzymesand degradative enzymes
Prick + prick technique are more reliable thanPrick + prick technique are more reliable thanstandard skin testsstandard skin tests Lancet is inserted in raw fruit or vegetable, withdrawnLancet is inserted in raw fruit or vegetable, withdrawn
and then used to prick the persons skinand then used to prick the persons skin
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LatexLatex--Fruit SyndromeFruit Syndrome
Allergy to latex often starts as:Allergy to latex often starts as:
Contact allergy to a latex protein, usuallyContact allergy to a latex protein, usually
through:through:
Abraded (nonAbraded (non--intact) skinintact) skin
Mucous membraneMucous membrane
Exposed tissue (e.g. during surgery)Exposed tissue (e.g. during surgery)
Inhalant allergy:Inhalant allergy:
Inhaled powder from latex glovesInhaled powder from latex gloves
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Latex AllergyLatex Allergy
CrossCross--reacting allergensreacting allergens
As antigen comes into contact withAs antigen comes into contact with
immune cells, repeated exposure leads toimmune cells, repeated exposure leads to
IgE mediated allergyIgE mediated allergy
Proteins in foods with the same structureProteins in foods with the same structure
as proteins in latex trigger the same IgEas proteins in latex trigger the same IgE
response when they are eatenresponse when they are eatenIn extreme cases can cause anaphylacticIn extreme cases can cause anaphylactic
reactionreaction
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Latex AllergyLatex Allergy
Related foodsRelated foods
Examples of foods that have been shown toExamples of foods that have been shown to
contain proteins similar in structure to latex:contain proteins similar in structure to latex:
BananaBanana -- MangoMango -- TomatoTomato
Citrus FruitsCitrus Fruits -- MelonMelon -- CeleryCelery
Kiwi FruitKiwi Fruit --P
ineappleP
ineapple -- AvocadoAvocado FigFig -- PapayaPapaya -- Tree NutsTree Nuts
Passion FruitPassion Fruit -- PeachPeach -- ChestnutChestnut
GrapesGrapes -- PotatoPotato -- PeanutPeanut
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Common allergens in unrelated plantCommon allergens in unrelated plant
materials:materials: SummarySummary
OAS and latex allergy are examples ofOAS and latex allergy are examples of
conditions in which common antigens,conditions in which common antigens,
expressed in botanically unrelated plants,expressed in botanically unrelated plants,are capable of eliciting a hypersensitivityare capable of eliciting a hypersensitivity
reactionreaction
In practice, when a specific plant foodIn practice, when a specific plant foodelicits an allergic response, foods in theelicits an allergic response, foods in the
same botanic family rarely elicit allergysame botanic family rarely elicit allergy
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Food IntolerancesFood IntolerancesBiochemical and PhysiologicalBiochemical and Physiological
ResponsesResponses
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Symptoms of Carbohydrate IntoleranceSymptoms of Carbohydrate Intolerance
Watery loose stool (diarrhea)Watery loose stool (diarrhea)
Abdominal bloating and pressureAbdominal bloating and pressure
Cramping pain in abdomenCramping pain in abdomen
FlatulenceFlatulence
VomitingVomiting
Poor weight gainPoor weight gain
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Cause of CarbohydrateCause of Carbohydrate
IntoleranceIntoleranceLack of the enzyme that digests theLack of the enzyme that digests thecarbohydratecarbohydrate
Lactose intolerance is due to the lack ofLactose intolerance is due to the lack oflactase:lactase:
Milk sugar (lactose) is not digestedMilk sugar (lactose) is not digested
Sucrose intolerance is lack of the enzymeSucrose intolerance is lack of the enzymesucrasesucrase
Sucrose (table sugar; syrup of all types; someSucrose (table sugar; syrup of all types; somefruits) is not digestedfruits) is not digested
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Management of Lactose IntoleranceManagement of Lactose Intolerance
Only the milk sugar, lactose, needs to be avoidedOnly the milk sugar, lactose, needs to be avoided
This is not a milk allergy:This is not a milk allergy:
Milk proteins are toleratedMilk proteins are tolerated
Lactose occurs in the whey (liquid) fraction of milkLactose occurs in the whey (liquid) fraction of milk
Milk products free from lactose and free from whey are safeMilk products free from lactose and free from whey are safe
These foods include:These foods include:
Milk treated with lactase (LactaidMilk treated with lactase (Lactaid;Lacteeze;Lacteeze))
Hard cheeses (whey is removed; casein remains and isHard cheeses (whey is removed; casein remains and isfermented to form cheese)fermented to form cheese)
Many people tolerate yogurt, where lactose is broken downMany people tolerate yogurt, where lactose is broken downby bacterial enzymesby bacterial enzymes
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Reactive Chemicals in FoodsReactive Chemicals in Foods
May act on the body in two ways:May act on the body in two ways:
chemical acts directly on body tissues ratherchemical acts directly on body tissues ratherlike a druglike a drug
chemical reacts with a system (stops orchemical reacts with a system (stops orenhances the process) that acts on the bodyenhances the process) that acts on the bodytissuetissue
Symptoms occur when the body is unableSymptoms occur when the body is unable
to get rid of the chemical quickly enoughto get rid of the chemical quickly enough The level in the body rises and the symptomsThe level in the body rises and the symptoms
that develop are due to the excessthat develop are due to the excess
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HistamineHistamine
Histamine reactions can be clinicallyHistamine reactions can be clinicallyindistinguishable from food allergyindistinguishable from food allergy
Hives, facial swelling, and headaches are examplesHives, facial swelling, and headaches are examplesof histamine excessof histamine excess
Tests for food allergy are usually negativeTests for food allergy are usually negative Histamine sensitivity is becoming recognized as aHistamine sensitivity is becoming recognized as a
disease entity quite distinct from allergydisease entity quite distinct from allergy
Sensitivity may be deficiency in the enzymes thatSensitivity may be deficiency in the enzymes that
break down excess histaminebreak down excess histamine Histamine intolerance can exacerbate allergy to theHistamine intolerance can exacerbate allergy to the
extent of eliciting an anaphylactic reaction whenextent of eliciting an anaphylactic reaction whenthe two conditions occur togetherthe two conditions occur together
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Sources of Histamine in FoodsSources of Histamine in Foods
Fermented foods:Fermented foods:
Microbial activity on proteins produces histamineMicrobial activity on proteins produces histamine
Examples:Examples:
CheeseCheese
Processed meats and sausages:Processed meats and sausages:
SalamiSalami
BolognaBologna
PepperoniPepperoni
Vinegar and foods containing vinegar:Vinegar and foods containing vinegar:
PicklesPickles
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Sources of Histamine in FoodsSources of Histamine in Foods
Fermented beverages:Fermented beverages:
WineWine
Beer, ale, lagerBeer, ale, lager
Fish and shellfish:Fish and shellfish:
Incorrectly storedIncorrectly stored Bacteria in the intestine of the fish start to breakBacteria in the intestine of the fish start to break
down fish proteindown fish protein
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Sources of Histamine in FoodsSources of Histamine in Foods
Some foods contain high levels of histamineSome foods contain high levels of histaminenaturally, especially:naturally, especially:
SpinachSpinach
EggplantEggplant
Berries (Berries (strawberries and raspberriesstrawberries and raspberries))
TomatoTomato
Citrus fruitsCitrus fruits (orange; lemon; lime; grapefruit)(orange; lemon; lime; grapefruit)
Some foods may release histamine by aSome foods may release histamine by amechanism which is only partially understoodmechanism which is only partially understood
example: egg whiteexample: egg white
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Other Sources of HistamineOther Sources of Histamine
MicroMicro--organisms in the body:organisms in the body:
Certain types of bacteria in the large bowelCertain types of bacteria in the large bowel
use undigested food material for theiruse undigested food material for their
reproduction and growthreproduction and growth
People with these microPeople with these micro--organisms absorborganisms absorb
histamine from their own intestinehistamine from their own intestine
It is possible that probiotic bacteria could beIt is possible that probiotic bacteria could beused to displace these strainsused to displace these strains
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Tyramine sensitivityTyramine sensitivity
Symptoms when tyramineSymptoms when tyramine--rich foods are eaten:rich foods are eaten:
Sharp rise in blood pressureSharp rise in blood pressure HeadacheHeadache
Caused by:Caused by:
Deficiency in the enzymes that break down
Deficiency in the enzymes that break downexcess tyramineexcess tyramine
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Tyramine in FoodsTyramine in Foods
Formed by microbial action in foodFormed by microbial action in foodpreparation:preparation: cheesecheese
winewine
yeast extractyeast extract vinegarvinegar
Small amounts occur naturally in someSmall amounts occur naturally in somefoodsfoods::
chicken liverchicken liver -- eggplanteggplant avocadoavocado -- tomatotomato
bananabanana -- plumplum
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Sensitivity to Food AdditivesSensitivity to Food Additives
Characteristics common to personsCharacteristics common to persons
sensitive to food additivessensitive to food additives::
History of asthma and hay feverHistory of asthma and hay fever
Occasionally hives and facial swellingOccasionally hives and facial swelling
Aspirin sensitiveAspirin sensitive
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Additives Most Frequently CausingAdditives Most Frequently Causing
IntolerancesIntolerances
Tartrazine (and other artificial food colours)Tartrazine (and other artificial food colours)
Preservatives:Preservatives:
SulphitesSulphites
BenzoatesBenzoates
SorbatesSorbates
Monosodium glutamate (MSG)Monosodium glutamate (MSG)
Nitrates and nitritesNitrates and nitrites
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Symptoms of Tartrazine SensitivitySymptoms of Tartrazine Sensitivity
Asthma in asthmaticsAsthma in asthmatics
UrticariaUrticaria
AngioedemaAngioedema
NauseaNauseaMigraine headachesMigraine headaches
Evidence of hyperactivity in childrenEvidence of hyperactivity in children
Excess tartrazine may increase levels ofExcess tartrazine may increase levels of
inflammatory mediators in allergy, such as:inflammatory mediators in allergy, such as:
leukotrienesleukotrienes important mediators in asthmaimportant mediators in asthma
histaminehistamine
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Foods Frequently ContainingFoods Frequently Containing
TartrazineTartrazine
Soft drinksSoft drinks
Liqueurs and cordialsLiqueurs and cordials
Candy and confectioneryCandy and confectionery
ReadyReady--toto--eat cerealseat cereals
Jams and jelliesJams and jellies
Ice cream, sherbet, milk shakesIce cream, sherbet, milk shakes
Commercial gravies and soup mixesCommercial gravies and soup mixes
Flavor packetsFlavor packets
Pickles, relish, salad dressingsPickles, relish, salad dressings
Prepared baked goodsPrepared baked goods
Smoked fish and fish productsSmoked fish and fish productsPurvi Kakrani & Dr. Harish KakraniPurvi Kakrani & Dr. Harish Kakrani
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Foods Frequently ContainingFoods Frequently Containing
TartrazineTartrazine
Snack foodsSnack foods
Meal replacementsMeal replacements
Any food containing artificial color mayAny food containing artificial color may
contain tartrazine unless it is labeledcontain tartrazine unless it is labeledtartrazine freetartrazine free
NonNon--food items:food items:
Medications (prescription and OTC)Medications (prescription and OTC)
Vitamin and mineral supplementsVitamin and mineral supplements
Toiletries and cosmeticsToiletries and cosmetics
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Sulphite SensitivitySulphite Sensitivity
Most common in asthmaticsMost common in asthmatics
SteroidSteroid--dependent asthmatics are most at riskdependent asthmatics are most at risk
Adverse reactions to sulphites is estimated to be asAdverse reactions to sulphites is estimated to be ashigh as 1% of the U.S. populationhigh as 1% of the U.S. population
Sulphite sensitivity in nonSulphite sensitivity in non--asthmatics is considered toasthmatics is considered tobe quite rarebe quite rare
Symptoms occur in most organ systems:Symptoms occur in most organ systems:
LungsLungs
Gastrointestinal tractGastrointestinal tract Skin and mucous membranesSkin and mucous membranes
LifeLife--threatening anaphylactic reactions inthreatening anaphylactic reactions inasthmatics have been recorded, but occur veryasthmatics have been recorded, but occur veryrarely.rarely.
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Symptoms Reported in SulphiteSymptoms Reported in Sulphite
SensitivitySensitivity
Urticaria (hives)Urticaria (hives)
Angioedema (swelling, especially of theAngioedema (swelling, especially of the
mouth and face)mouth and face)Contact dermatitisContact dermatitis
Anaphylaxis (in asthmatics)Anaphylaxis (in asthmatics)
Anaphylactoid reaction (nonAnaphylactoid reaction (non--asthmatics)asthmatics)
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Forms of Sulphites Permitted inForms of Sulphites Permitted in
FoodsFoodsSulphites are permitted in the form of:Sulphites are permitted in the form of:
Sodium metabisulphiteSodium metabisulphite
Potassium metabisulphitePotassium metabisulphite Sodium bisulphiteSodium bisulphite
Potassium bisulphitePotassium bisulphite
Sodium sulphiteSodium sulphite
Sodium dithioniteSodium dithionite
Sulphurous acidSulphurous acid
Sulphur dioxideSulphur dioxidePurvi Kakrani & Dr. Harish KakraniPurvi Kakrani & Dr. Harish Kakrani
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Forms of Sulphites Permitted inForms of Sulphites Permitted in
FoodsFoodsUse of sulphites on fresh fruits and vegetables notUse of sulphites on fresh fruits and vegetables notallowed except on sliced raw potatoes and raw grapesallowed except on sliced raw potatoes and raw grapes
Sulphites are not allowed on raw foods in salad barsSulphites are not allowed on raw foods in salad barsor for sale in markets, with the above exceptionsor for sale in markets, with the above exceptions
U.S. government regulations require sulphites inU.S. government regulations require sulphites inexcess of 10 ppm in manufactured foods andexcess of 10 ppm in manufactured foods andbeverages, including alcoholic beverages, to be listedbeverages, including alcoholic beverages, to be listed
on labelson labelsSulphites are permitted in a wide rage of dried,Sulphites are permitted in a wide rage of dried,frozen, and processed foods, sweeteners, and snackfrozen, and processed foods, sweeteners, and snackfoodsfoods
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Sulphite SensitivitySulphite Sensitivity
There is no evidence that avoiding all sources ofThere is no evidence that avoiding all sources ofdietary sulphites improves asthmadietary sulphites improves asthma
Exposure to sulphiting agents poses very little risk forExposure to sulphiting agents poses very little risk for
individuals who are not sensitive to sulphitesindividuals who are not sensitive to sulphites
Sulphites in foods are not denatured by cookingSulphites in foods are not denatured by cooking
Sulphites avidly bind to several substances in foods,Sulphites avidly bind to several substances in foods,
such as protein, starch, and sugars. They are notsuch as protein, starch, and sugars. They are not
removed by washingremoved by washing
Sulphates do not cause the same adverse reactionsSulphates do not cause the same adverse reactions
as sulphites. They are inert in the body and need notas sulphites. They are inert in the body and need not
be avoided by people who are sensitive to sulphitesbe avoided by people who are sensitive to sulphites
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Benzoate IntoleranceBenzoate Intolerance
SymptomsSymptoms
Reported to induce:Reported to induce:
UrticariaUrticaria
AngioedemaAngioedema
AsthmaAsthma RhinitisRhinitis
Purpura (allergic vasculitis)Purpura (allergic vasculitis)
Hyperactivity in childrenHyperactivity in children
May lead to increase in histamineMay lead to increase in histamine
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Benzoates and Parabens:Benzoates and Parabens:Use in FoodsUse in Foods
One of the most commonly used foodOne of the most commonly used foodadditives worldwideadditives worldwide
Benzoic acid and sodium benzoateBenzoic acid and sodium benzoate
(benzoates) are used as antibacterial and(benzoates) are used as antibacterial andantimycotic agents in foods and beveragesantimycotic agents in foods and beverages
Benzoates are most effective as preservingBenzoates are most effective as preservingagents at an acidic pHagents at an acidic pH
Benzoyl peroxide is used as a bleachingBenzoyl peroxide is used as a bleachingagent, especially in white flour, white bread,agent, especially in white flour, white bread,and some white Italian cheesesand some white Italian cheeses
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BenzoatesBenzoates
Naturally occurringNaturally occurring
Benzoates occur widely in nature as simpleBenzoates occur widely in nature as simplesalts (sodium, potassium), esters, and amidessalts (sodium, potassium), esters, and amides
Natural benzoates are present at the highestNatural benzoates are present at the highest
levels in:levels in: Cinnamon, Clove, Anise, NutmegCinnamon, Clove, Anise, Nutmeg
PrunesPrunes
Black TeaBlack Tea
BerriesBerries
Especially Raspberry and CranberryEspecially Raspberry and Cranberry
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Monosodium Glutamate (MSG)Monosodium Glutamate (MSG)
Flavouring common in Chinese cookingFlavouring common in Chinese cooking
and increasingly used to flavourand increasingly used to flavour
Western foodsWestern foodsSensitive individuals report a variety ofSensitive individuals report a variety of
symptoms that are usually classified assymptoms that are usually classified as
Chinese Restaurant Syndrome (alsoChinese Restaurant Syndrome (alsoknown as Kwoks syndrome)known as Kwoks syndrome)
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MSG SensitivityMSG Sensitivity
Experts are widely divided on theExperts are widely divided on thesubject of MSG sensitivitysubject of MSG sensitivity
One review led to the conclusion thatOne review led to the conclusion that
Chinese Restaurant Syndrome is anChinese Restaurant Syndrome is ananecdote applied to a variety ofanecdote applied to a variety ofpostprandial illnessespostprandial illnesses
Some clinicians have estimated that theSome clinicians have estimated that theprevalence ofChinese Restaurantprevalence ofChinese RestaurantSyndrome may be as high 1.8% of theSyndrome may be as high 1.8% of theadult populationadult population
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Characteristics of MSG SensitivityCharacteristics of MSG Sensitivity
Alcohol may increase the rate of absorptionAlcohol may increase the rate of absorption
of MSG and increase theof MSG and increase the severityseverityandand rate ofrate of
onsetonsetof symptomsof symptoms
Symptoms usually occur about 30 minutesSymptoms usually occur about 30 minutesafter eating a meal high in MSGafter eating a meal high in MSG
Asthma occurs 1 to 2 hours after MSGAsthma occurs 1 to 2 hours after MSG
ingestion, and even as long as 12 hours lateringestion, and even as long as 12 hours laterVitamin B6 (pyridoxine) deficiency may be aVitamin B6 (pyridoxine) deficiency may be a
factor in some MSG sensitive peoplefactor in some MSG sensitive people
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Sources of MSGSources of MSG
Present in many flavouring mixtures:Present in many flavouring mixtures:
AccentAccent ZestZest
Gourmet powderGourmet powder GlutaveneGlutavene
GlutacylGlutacyl Chinese seasoningChinese seasoning
SubuSubu VetsinVetsin
AjinomotoAjinomoto Kombu extractKombu extract
MeiMei--jingjing WeiWei--jingjing
RLRL--5050
Hydrolysed vegetable protein (HVP)Hydrolysed vegetable protein (HVP)
Hydrolysed plant protein (HPP)Hydrolysed plant protein (HPP)
Natural flavour (may be HVP)Natural flavour (may be HVP)
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Sources of MSGSources of MSG
Used as a flavouring in foods, especially inUsed as a flavouring in foods, especially inChinese cooking, in canned foods (e.g.Chinese cooking, in canned foods (e.g.
soups), and restaurant mealssoups), and restaurant meals
Some sensitive individuals will also react toSome sensitive individuals will also react tomonopotassium glutamatemonopotassium glutamate
Several foods, such as tomato, mushrooms,Several foods, such as tomato, mushrooms,
and cheese contain natural glutamatesand cheese contain natural glutamates
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5454
Nitrate and Nitrite SensitivityNitrate and Nitrite Sensitivity
Nitrates and nitrites are used in foods asNitrates and nitrites are used in foods aspreservativespreservatives
Particularly protective againstParticularly protective against ClostridiumClostridium
botulinumbotulinumImpart flavour and preserve colour inImpart flavour and preserve colour inmanufactured foods, especially meatsmanufactured foods, especially meats
SymptomsSymptoms
Reports of headache in sensitive individualsReports of headache in sensitive individuals
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Nitrates and Nitrites in FoodsNitrates and Nitrites in Foods
Labels list sodium nitrate, potassium nitrate,Labels list sodium nitrate, potassium nitrate,
sodium nitrite, and potassium nitrite insodium nitrite, and potassium nitrite in
manufactured foodsmanufactured foods
Present at high levels in processed meats:Present at high levels in processed meats:
PepperoniPepperoni FrankfurtersFrankfurters
Hot Dog WienersHot Dog Wieners SalamiSalami
BolognaBologna Other Luncheon MeatsOther Luncheon Meats
BaconBacon HamHam
Smoked FishSmoked Fish Some Imported CheesesSome Imported Cheeses
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Nitrates in Plant FoodsNitrates in Plant Foods
Nitrates occur naturally in plants: the majorNitrates occur naturally in plants: the majorsource is nitratesource is nitrate--containing fertilizerscontaining fertilizers
Some species of plants tend to accumulateSome species of plants tend to accumulate
nitrates more than others:nitrates more than others: SpinachSpinach CeleryCelery
BeetsBeets LettuceLettuce
RadishesRadishes CollardsCollards
Turnip GreensTurnip Greens EggplantEggplant
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SummarySummary
Food allergy is most prevalent in babies and childrenFood allergy is most prevalent in babies and childrenFood intolerances predominate in adultsFood intolerances predominate in adults
Infant onset food allergy is mostly due to Class 1Infant onset food allergy is mostly due to Class 1allergensallergens
Sensitization is by ingestion of allergenSensitization is by ingestion of allergenAdult onset food allergy mostly due to Class 2 allergensAdult onset food allergy mostly due to Class 2 allergens
Sensitization by allergen inhalation or contactSensitization by allergen inhalation or contact
Food allergy: must avoid all sources of the allergenFood allergy: must avoid all sources of the allergen
Food intolerance: dose relatedFood intolerance: dose related
Several additional factors sometimes required to elicitSeveral additional factors sometimes required to elicitsymptomssymptoms
Food intolerance can exacerbate food allergyFood intolerance can exacerbate food allergy
P i K k i & D H i h K k iP i K k i & D H i h K k i