15. food allergy

7/28/2019 15. Food Allergy

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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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15. food allergy

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