allergens (57)

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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

Purvi Kakrani & Dr. Harish KakraniPurvi Kakrani & Dr. Harish Kakrani

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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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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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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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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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1818

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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1919

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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2020

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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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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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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4343

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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5555

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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5656

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

allergens (57)

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