Food allergy

Dewi Kumara Child Health Dept

May 21, 2007

smt vi lecture, foodallergy

Definition

a group of disorders distinguished by the way the body's immune system responds to specific food proteins. Most by type I hypersensitivity reaction

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smt vi lecture, foodallergy

Adverse reaction to food

General terminology toward unwanted reaction to food. Maybe secondary to food allergy or intolerance to food

May 21, 2007

smt vi lecture, foodallergy

Food intolerance

Is a non immunological reaction The most common cause of adverse reaction to food. Maybe caused by toxic contaminant ( histamine in scromboid fish, toxin secreted by salmonella, shigella, camphylobacter) Pharmacologic (cafein in coffee, tyramine in cheese) Genetic: metabolism disorder( lactase/maltase deficiency)

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smt vi lecture, foodallergy

Adverse reaction to food

Immunologic

Non immunologic

Type I Hypersensitivity Other type hypersensitivity

Toxic

pharmacologic

metabolism

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smt vi lecture, foodallergy

Some children may also be intolerant of food colorings, additives, and preservatives. Among these are yellow dye number 5, which can cause hives; and monosodium glutamate, which produces flushing, headaches, and chest pain. Sulfites, another additive, have been found to cause asthmatic reactions and even anaphylactoid reactions. Sulfites are preservatives used in wines, maraschino cherries, seafood, and soft drinks. They are sometimes put on fresh fruits and lettuce to maintain their fresh appearance, on red meats to prevent brown discoloration, and even in prepared deli foods like crab salad. Sulfites appear on food labels as sodium sulfite, sodium bisulfite, potassium bisulfite, sulfur dioxide, and potassium metabisulfite. The U.S. Food and Drug Administration (FDA) has banned the use of sulfites as a preservative for fruits and vegetables, but they are still in use in some foods.

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smt vi lecture, foodallergy

Statistics:

Eight percent of children < 6 years experience food intolerances. Of this group, 2 to 4%: allergic reactions to food. Peanut and/or tree nut (e.g. walnut, almond and cashew) allergy affects about three million Americans, or 1.1% of the population. In US, 150 die / year from food-related anaphylaxis. .

May 21, 2007

smt vi lecture, foodallergy

Etiology of food allergy

Children Adult
peanuts tree nuts fish shellfish

The majority cause

milk egg peanuts wheat soy tree nuts (walnuts and pecans
smt vi lecture, foodallergy

Children will often outgrow their allergy to these food protein

May 21, 2007

Phatophysiology

Allergen in food:

is a protein, glicoprotein or polypeptides Molecular weight > 18 000 Dalton Resistant to heat Resistant to proteolytic enzymes Fish: allergen M, egg: ovomucoid (major), cows milk:lactoglobulin (BLG), lactalbumin (ALA), bovine serum albumin (BSA), bovine globuline (BGG)

May 21, 2007

smt vi lecture, foodallergy

Fish: allergen M egg: ovomucoid (major), cows milk:lactoglobulin (BLG), lactalbumin (ALA), bovine serum albumin (BSA), bovine globuline (BGG) Peanut: arachin, conarachin Shrimp: allergen-1, allergen 2 Wheat: albumin, pesudoglobuline, euglobuline

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Pathogenesis
allergen TH2 activation by Allergen IgE class switching in B cell

Vasoctive amine: histamine,serotonin , protease lipid mediators: prostaglandin, Leukotriene

GIT, RT,CV

Cytokine: IgE secreting plasma cell Binding of IgE to FcRI on mast cells
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Degranulation of mast cell: release mediators

Late phase reaction: 2-4 hrs

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Predisposing factors associated with Food allergy

Genetic : risk of allergy from parent GI immaturity: GI mucosal integrity, peristaltic , enzymes, acidity, sIgA Allergen exposure : in utero milk, breastmilk, norm & tradition in certain area.

Triggering factors are not the cause. Without exposure, triggering factors are not matters. Could be cold, heat, rain, psychological stress, excercise

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Clinical manifestation

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smt vi lecture, foodallergy

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Clinical manifestation

GIT: tingling, itchy mouth, edema mouth, tongue, palatum, pharyngeal, nausea/vomitting, abdominal cramp, distention, diarrhea, bleeding, protein losing enteropathy Respiratory tract: Rhinitis, asthma, recurrent chronic cough, difficult breathing Skin: hives, angioedema, atopic dermatitis Cardiovascular: drop in blood pressure anaphylaxis shock death eyes ache,

Food induced anaphylaxis: peanut, sea fish, shrimp, cows milk, egg, soy

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Symptoms of food allergies

Symptoms typically appear within minutes to two hours after the person has eaten the food to which he or she is allergic. Individuals with food allergy and asthma appear to be at an increased risk for severe or fatal allergic reactions.

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smt vi lecture, foodallergy

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Laboratory investigation

Skin test CBC CXR IgE total & Specific

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smt vi lecture, foodallergy

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Information obtainable from history

Description of symptom & sign Timing from ingestion to onset of symptoms Frequency with which reactions have occurred Time of most recent occurrence Quantity of food required to evoke reaction Associated factors (activity) Medication Reproducibility, esp for subjective symptoms (behaviour, headache) Potential cross-contact (contamination of other foods, dust mites)

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Diagnosis

(Elimination and ) Provocation test

Not done if clinical manifestation is anaphylactic and laryngeal edema

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Management

Based on symptoms Pharmacotherapy Avoidance

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Prognosis

Can not be cured Control symptom, reduce intensity Reduce frequency Reduce medication use Reduce absence day Dermatitis reduce after 12 year

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Can food allergies be prevented?

Breast feed at least 4 months (preferably at least 6 months) Avoid exposure to tobacco smoke and don't smoke during pregnancy Delay the introduction of solids until age 4-6 months Introduce new foods one at a time so that allergic reactions can be more readily identified Introduce rice, vegetables, meat and fruits first Delay the introduction of egg until at least 12 months Delay the introduction of nuts and seafood until at least 24 months

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There is little or no evidence at this time that severely restricting a mother's diet during pregnancy will prevent food allergy. Indeed, severe restrictions may affect the nutrition of the developing baby. There is some evidence that certain dietary restrictions during breast feeding may be of some benefit. Any food avoidance should be done with medical or dietetic advice so that maternal nutrition is not compromised.

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Case

A girl, 5 years old, complaining of red wheal all over the body, started a day before admission. This is the second episode after the same complaint 4 month ago. Her mother did not notice any possible cause, but, history taking showed that patient is an-egg lover, who has been consumed 4-5 egg everyday since she was 3 years-old. Father has asthma, but mother is generally well. In this case:
1.
2. 3. 4. 5. 6. 7.

What is the mechanism that underlying the clinical manifestation, if egg is really a cause of the red wheal? Food allergy mediated by immunoglobulin (Ig). Which class of Ig it is ? What is the role of loving egg for the development of the disorder? What is the importance of parental history? Do you have any other question to ask to parents. Name them. What test(s) that you plan for the patient? What is your suggestion for the management of the case?

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Learning task

In true food allergy, what mechanism that related to the clinical manifestation Why food allergy manifests in various organ systems? What test are needed to support diagnosis of food allergy? What tests are needed to confirm food allergy ? What are the basic principles of management of food allergy

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