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FOOD ALLERGY
By
NURPUDJI ASTUTI
SCHOOL OF MEDICINE
HASANUDDIN UNIVERSITYMAKASSAR
2003
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WHAT IS FOOD ALLERGY
Is a response of the immune systemto a component of food, almostinvariably a protein
Or
A molecule linked to a protein, thatthe immune system recognizes as aforeign to the body
Or
FOOD HYPERSENSITIVITY
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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 BYCOMBINATION OF THIS TYPES.
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FOOD ALLERGY
IS COMMON IN INFANCY
PREVALENCE 1 3%
ONLY REPRESENTS A SMALLPROPORTION OF FOOD REACTION
IN THE ADULT.
SOMETIMES FOOD ALLERGY ISLIFELONG
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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 SPECIFICIgE ANTIBODIES
IgE MOLECULES COUPLE WITH RECEPTORS ON THESURFACE OF MAST CELLS ( IN TISSUES) AND BASOPHYL( IN BLOOD)
NO SYMPTOMS ARE OBSERVED ON FIRST EXPOSURE TOTHE ALLERGEN
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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
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TYPE IV HYPERSENSITIVITY
T cell lymphocytes and cytokines
Called as contact allergy
T-cells lymphocytes respond to theallergen - release of cytokine.
An immediate reaction when thry comeinto contact with the lips, tongue, mouth
and GIT. Example: Nickel allergy
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Allergy
as an Inflammatory Process
Symptoms of allergy result from the release ofinflamatory mediators
Histamin increases the permeability of
capillaries swellingRhinitis is due to fluid buildup in tissues in
nasal passages
Excessive fluid in the skin causes urticaria(hives) and angioedema
Histamin also causes itching andvasodelation, resulting in flushing orreddening of the skin
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Continue ----
Allergy as an Inflammatory Process
Prostaglandins caused vasodelation andvasocontriction
Leukotrienes - contraction of smooth musclebronhospasm of asthma
Bradykinin in conjunction with prostaglandinscauses 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
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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
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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 ALLERGENS6. EXERCISE
7. CHANGES IN HORMONE LEVEL
8. STRESS
9. FREQUENCY OF EXPOSURE
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ADVERSE REACTION
TO FOOD ADDITIVES
FOOD ADDITIVES;
any substance, including any source ofradiation, the used of which results, ormay reasonably be expected to result, init or its by products becoming a part of oraffecting the characteristics of food
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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
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SOURCE OF FOOD ADDITIVES
CHEMICAL ADDITIVES --- USED EXTENSIVELY INMANUFACTURED FOODS
PROBLEMS FOR PERSONS WITH FOOD SENSITIVITIES
CHEMICALS; DIVERSE IN COMPOSITION AND TYPES
DERIVED FROM NATURAL SOURCES ( CHEMICALPROCESSES) & SYNTHESIZED FROM INORGANICSOURCES.
??? ---- VERY LITTLE UNDERSTANDING OF HOW THECHEMICAL CAUSES THE ADVERSE CLINICAL EFFECTS
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CLINICAL REACTIONS
TO FOOD ADDITIVES
Urticaria
Angioedema
Asthma
Rhinitis
Headache
Irritable bowel syndrome
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clinical reaction continues -----
HYPERACTIVITY
FOOD COLORS
PRESERVATIVES
MANY FOODS
SENSITIVITY TO MONO SODIUM GLUTAMATE
SYMPTOMS RESEMBLE TO MYOCARDIAL
INFARCTION, INCLUDING TIGHTNESS AND
PAIN IN THE CHEST WHICH RADIATES
TO THE ARMS, PALPITATIONS AND
FAINTNESS.
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IDENTIFYING SENSITIVITY TO FOOD
ADDITIVES
SAIFER AND SAIFER
USED ANECDOTAL MARKERS, ONE OF THE SIGNS ISDEVELOPMENT OF SENSITIVITY TO ALCOHOL,STARTING WITH ADVERSE REACTIONS TO RED WINE &BEER, AND FOLLOWED BY WHITE WINE ANDDESTILLED SPIRITS.
SENSITIVITY TO INGESTED CHEMICALS, SUCH ASGASOLINE, CIGARETTE SMOKE, PAINT SOLVENTS,HOUSE-HOLD CLEANERS
INDICATORS OF CHEMICAL FOOD ADDITIVE INTOLERANCEARE MULTISYSTEM RAECTIONS, ESPECIALLY CENTRAL
NERVUS SYSTEM SUCH AS: HEADACHE, FATIGUE, MUSCLEWEAKNESS, SKIN AND RESPIRATORY SYMPTOMS.
AT PRESENT, THE ONLY INDICATOR OF FOOD ADDITIVESINTOLERANCE IN MOST CASES IS ELEMINATION ANDCHALLENGE WITH FOODS CONTAINING THE SUSPECTEDADDITIVE(S)
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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 OTHERGLUTAMATES
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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, cows milk, and eggMost study --- 80% of atopic children are allergic
to only one or two foods.
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Continues ---
Anaphylactic reaction to cows milk, egg,wheat and chicken in children under threeyear of age
Infant and toddlers tend to outgrow earlyallergies to certain foods, such as milk,egg, wheat and soy
Food allergy occurs after 3 yo, the allergyis likely to be outgrown.
Allergies to certain other foods to beoutgrown or may persist for a personslifetime --- such as: peanuts, nut, shellfishand fish.
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Foods implicated in
anaphylactic reactionsNUTS
Peanuts
Pecan
Pistachio
Cashew
Brazil
pinom
Seeds
Millet
Subflower
Sesame
Cottonseed extract
Annatto ( color )
Psyllum
Grains
WheatRice
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Continues --
Vegetables
PotatoCelery
Pea
Pinto bean
Soybean
ChickpeaCorn
Fruitorange
Tangerine
Mango
Banana
Kiwi fruit
Poultry
chicken
EggHen
Fish
Cod
Halibut
Beverages
Chamomile teawine
Shellfish
crab
Shrimp
Lobster
Limpet
Milk products
cows milk
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ALLERGENIC CROSS-REACTIVITY BETWEEN
BOTANICALLY RELATED PLANTS
CROSS REACTIVITY DEFINED AS A CONNECTIONBETWEEN TWO OR MORE ALLERGENS, WHEATHERRELATED OR NOT, THAT CAUSES OF THEM TO INDUCESIMILAR CLINICAL REACTIONS
NOT VALID PLANTS BELONG TO THE SAME FAMILY,THEY ARE NECESSSARILY RELATED ANTIGENECALLY
ALLERGIC REACTION TO A SINGLE SPECIES DOES NOTAUTOMATICALLY LEAD TO ALL MEMBERS OT THAT
PLANT FAMILY
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ALLERGENIC CROSS-REACTIVITY BETWEEN
UNRELATED PLANT SPECIES
RECENT STUDY HAS
DEMONSTRATED THE PRESENCE OF
CROSS REACTING ANTIGRNS INBOTANICALLY UNRELATED,
ALLERGENIC PLANT SPECIES.
THE ALLERGENS MAY BE INHALED
OR CONSUMED AS FOOD
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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.
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Continues ---- FOOD ALLERGY
Lesson two
THURSDAY, OCTOBER 16TH, 2003
Nurpudji Astuti
Nutrition Department School of MedicineHasanuddin University
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ALLERGENIC POTENTIAL FOOD
TO WHAT EXTENT SHOULD A KNOWN ALLERGEN BEAVOIDED ???
example: person allergic to soy, should all form of soy beeliminated from the diet, including hydrolyzedsoy protein, lecithin made from soy, fermentedsoy ( soy sauce) and so on??
FOR SAFETY, THE ALLERGIC PERSON IS USUALLY ADVISEDTO 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 ofingredients in manufactured foods.
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DEGREE OF INDIVIDUAL REACTS
Depends on a number of factors,including the allergenic potency of thefood.
Mildly allergic to food --- fewerprecautions need be taken in detectingthe food as hidden ingredient.
Avoid all --- allergic food precipitate a lifethreatening anaphylactic reaction.
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FOODS MOST LIKELY TO CAUSE A SEVERE
REACTION IN THE HYPERSENSITIVE PERSON
Peanuts
Green peas
Tree nut
Shellfish
Finfish
Egg white
Cows milk protein in infants
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QUANTITY OF FOOD REQUIRED TO CAUSE
AN ALLERGIC REACTION
Depend on the potency of the allergen
The allergic persons 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
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Food additives derived from potentially
allergenic foods
Name Source Foods likely to contain
the additive
Function of
foods
Lecithin
Annatto
Egg
Egg yolk
Soy beanCorn
Extract fromthe seed of
tropical tree
Boxed breakfast cereal
Candy
ChocolatesBreads, rolls, burns
Margarine
Dairy products (cheese,butter)
Breakfast cereal
Baked goods
margarines
Antioxidant and
emollient
composed ofcholine,
phosphoric acid,
fatty acids and
glycerin
Coloring agent
( yellow to pink)
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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
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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 readilyavailable as from animal sources
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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)
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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 lactosevariety 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
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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
mothers 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.
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TREATMENT
COMPLETE DIETARY EXCLUSION OF
COWS MILK
70 -80% ALLERGIC TO COWS ARE ALSO
ALLERGIC TO GOATS MILK PROTEINS
MILK SUBSTITUTE IS USUALLY
NECESSARY
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Peanut allergy
Peanuts are legumes
Peanuts and soy the most allergenic of thefamily leguminosae 30 species including
fresh or dried peas and beans, all type lentils,soy beans, carob and licorice.
Symptomatic reactivity to more than onemember of the legume family is rare
Reaction to peanut, soy, and other legume aremanaged separate allergies.
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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 andcumbersome if all traces of peanuts are
avoided, as well as all traces of other nuts.
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Warning !!!!!!!!!
Sometimes no differentiation is made in marketingpeanuts and other nuts, and the two are soldtogether in nut mixtures.
In the manufacture of candies, confectioneries andice creams, cross contamination occurs betweennuts and peanuts.
Result persons with severe peanut allergy shouldbe advised to avoid any product containing anytype ofNUT because the danger of encounteringpeanuts inadvertently.
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Symptoms of Peanut Allergy
the allergy is considered to be lifelong
Urticaria
Angioedema
Wheezing
Asthma Vomiting
Rhinorrhea
Itching --- contact dermatitis
Nausea Allergic conjunctivitis
anaphylaxis
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Studies have indicated that peanutsallergic adult can tolerate pure peanut oilwithout any clinical reactions.
The allergic reactivity occurs to the
protein not to the oil
However, because traces of the proteinmay contaminate the oil, individuals who
are anaphylactic to peanut, or to anyanother plant, should be cautioned toavoid oil derived from allergenic plant.
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EGG ALLERGY
Mayor proteins for egg allergy present in egg whiteOvalbumin
Conalbumin ( ovotransferrin )
Ovomucoid
Yellow egg present as livetins derived from theblood of the hen
Cross reactivity may occur between white andyellow egg
Ovomucoid is heat stable, persons allergic to thiscomponent react to both cooked and raw egg
Ige Antibodies are produces to egg proteins, whichdiffer from the protein in chicken flesh
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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.
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PROTEIN COMPOSITION OF EGGS
56 -61% OF THE WEIGHT OF
CHICKEN EGGS IS THE WHITE
27 -32% IS YOLK
THE REST IS SHELL
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EGG WHITE PROTEINS
OVALBUMIN
CONALBUMIN
OVOMUCOID
OVOMUCIN
LYSOZYME
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EGG YOLK PROTEINS
LIPOVITELLIN
PHOSVITIN
LOW DENSITY LIPOPROTEINS
LIVERTONS
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TRACE AMOUNTS OF OTHER PROTEINS
CATALASE
OVOFLAVOPROTEIN
FICIN INHIBITOR
OVOGLYCOPROTEING2 AND G3 GLOBULINS
OVOMACROGLOBULIN
RIBONUCLEASEOVOINHIBITOR
AVIDIN
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