11/2/2015

Managing Food Allergies

and Food Intolerance

Diniyah Kholidah
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Food Allergy vs Food Intolerance

Food Allergy
vs.
Food Intolerance

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Food Allergy vs Food Intolerance

What about
Allergy VS
Intolerance!

Food Allergy

True Allergy-Total avoidance

necessary !
Intolerance- Small amount may be
tolerated !
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Gejala tampak jelas

Reaksi segera timbul (1 jam)
Onset cepat dan semakin bertambah
Terjadi dgn makan sedikit alergen
Dipengaruhi oleh IgE
Alergi tidak sering terjadi
Umumnya tidak dapat kembali
Dapat diatasi dengan pengobatan
Test : prick test, blood test/RAST

Food Intolerance
Gejala tidak jelas/tidak kentara
Reaksi lambat (12-72 jam)
Onset lambat, berhenti jika tdk ada pemicu
Terjadi jika makan dlm jumlah tertentu
Dipengaruhi oleh IgG, PG, leukotriene
Intoleransi sering terjadi
Dapat terjadi berulang
Mulai diatasi dengan pengobatan
Test : EGS (electro dermal screening), IgG
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Food Allergy Symptoms

Gatal2, rasa panas dan
bengkak disekitar mulut
Bersin-bersin, ingusan
Ruam kulit (eczema)
Bintik merah (urticaria)
Diare, kejang perut
Sesak napas, mengi dan
asthma
Mual dan muntah

Alergi Makanan

Food Intolerance Symptoms

gelisah, gemetar
berkeringat
Berdebar-debar
Nafas cepat dan pendek
Sakit kepala, migraine
diare
Rasa panas dikulit
Sesak napas - asthma-like
symptoms

Alergi makanan = reaksi hipersensitivitas thd makanan

Alergi makanan adalah,
manifestasi hiperesponsivitas imunologik terhadap antigen
spesifik (berasal dari makanan/protein bahan makanan).
Alergi makanan :
proses inflamasi cepat/lambat ok. penyimpangan reaksi
fisiologi pd jaringan tubuh akibat interaksi suatu antigen
dgn suatu antibodi setelah menelan berbagai jenis
makanan.

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Definition of Food Allergy

Risk Factors Associated With Food Allergy

And Anaphilaxis

Food allergy occurs when the immune system, by means

of a mixture of immune cells, antibodies and chemical
mediators, reacts in an attempt to reject a food.

Risk factors linked with food allergy:

family history of allergy and asthma
genetic predisposition to allergic disease
age (< 3 years old)
elevated allergen-specific serum IgE concentration

York Nutritional Laboratories, Inc.

Type I Hypersensitivities Involve IgE

Risk factors associated with fatal or near-fatal anaphylaxis:

a history of food allergy, especially if severe
allergy to peanuts or tree nuts
asthma, typically mild asthma
adolescence/young adulthood
delay in appropriate treatment

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Who makes the immunoglobulin IgE?

Figure 12-2
The allergen enters the body
and is recognized by sIg on a
B-lymphocyte. The Blymphocyte proliferates and
differentiates into plasma cells
that produce and secrete IgE
against the allergen.

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Picture credit: used with permission from Dr. Gary E. Kaiser

http://www.cat.cc.md.us/courses/bio141/lecguide/index.html

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ALLERGY

Whats next?

Food protein

Sensitization

The next time the

allergen enters the
body, it cross-links
the Fab portions of
the IgE bound to the
mast cell. This
triggers the mast cell
to degranulate, that
is, release its
histamine and other
inflammatory
mediators.

B cell

T lymphocyte

Anaphylaxis

IgE
Food

Antibody

Skin-

itchiness, flushing,
hives, swelling, eczema

Elicitation/
Reactivity

GI-

nausea, vomiting,
abdominal pain, diarrhea

Respiratory- tightness,
runny nose, wheezing,
throat closing/swelling

Vascular-

dizziness, low
blood pressure, heart
irregularities, shock

Picture credit: used with permission from Dr. Gary E. Kaiser

http://www.cat.cc.md.us/courses/bio141/lecguide/index.html

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Mast cell/ Basophil

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Food protein

B cell

* IgE

Antibody

IgE

T cell

Food/Protein

Antibody

Sensitization

Subjective

Elicitation/ Reactivity
Dose-dependent release of mediators,
cytokines (Amplification mechanism)
Rapidly progresses in severity

Few individuals affected - genetic

AND environmental factors
Exposure, cultural, ??processing

Mast cell/ Basophil

Diagnose by * food-specific IgE levels

Risk assessment: Novel food proteins

Food protein

Allergenicity safety assessment of foods derived from

recombinant DNA plants- Codex Alimentarius, 2003

IgE independent ~20%

initial meeting of an allergen and the immune system

that results in IgE production!

Activation of mast cells

Varies according to allergen type/

bioavailability / meal
GI absorption, alcohol use
Food matrix, exercise

Specific IgE levels poor predictors

Genetics/ host sensitivity to mediators
Risk assessment: Allergen Thresholds

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Safe exposure dose

Biological end points?

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Tissue Affected
Nature of IgE Allergic Reactions

The tissues most commonly affected are the skin, the respiratory
tract and the alimentary tract. The results are at best
uncomfortable (e.g. hay fever, eczema, food allergy) at worst fatal
(asthma, anaphylaxis)

Antigen + IgE + Mast cells = Mediator release

Mediators= histamine and others
Picture credit: used with permission from Dr. Gary E. Kaiser
http://www.cat.cc.md.us/courses/bio141/lecguide/index.html

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Body Part Affect

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Symptoms-Food Allergy*

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Anaphylaxis
Setelah beberapa menit alergen masuk ke dalam tubuh,
seseorang dapat terancam jiwanya dengan beberapa gejala
yaitu :

Nausea
Diarrhea
Abdominal cramps
Pruritic rashes
Angioedema
Asthma/rhinitis
Vomiting
Hives
Laryngeal edema
Anaphylaxis

Susah bernafas dan nafas berbunyi gaduh

Bengkak pada lidah
Bengkak/sesak pada tenggorokan
Kesulitan bicara / suara parau
mengi atau batuk persisten
Kebingungan / kolaps
Lemah dan pucat (pada anak)
kematian

* Exercise exacerbates symptoms

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What Foods Cause Food Allergies?

Infants at risk for food allergy

Breastfeeding is the best option for most infants.

Food Allergy: Prevention

Exclusive breastfeeding is recommended
Eliminate foods that cause infant allergies from the
mothers diet while breastfeeding - avoid peanuts, nuts
Delay solid foods until 6 months of age
1 year of age: Introduce cows milk and milk product
2 years of age: Introduce eggs
3 years of age: Introduce peanuts, other nuts, fish, shellfish

Shellfish

Children will often

outgrow an allergy to
eggs, milk and soy.

(walnuts, pecans, almonds,

cashews, hazelnuts, etc)

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Common Food Allergies in Adults

Common Food Allergies in Children

Cows milk
Eggs
Peanuts
Tree nuts
Soybeans
Wheat

Peanuts
Shellfish
Fish
Tree nuts

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Oral Challenge Test

Diagnostic Techniques

Diet Diary (dietary analysis)

Normal dietary habits
Enter throughout the day
Symptoms or improvement (masking)
Evaluation
Elimination
Test food should be eaten every day x 2wks
Eliminate the test food completely x 4 days
Day 5: eat breakfast, drink nothing but water for 5
hours prior to test
Challenge

Oral challenge test

Skin testing
In vitro testing
IgG RAST, IgE RAST
Enzyme-linked immunosorbant assay/activated
cell test
Difficult to reproduce
Immunoglobulin levels do not imply clinical dz

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TES DIET ELIMINASI

TES DIET ELIMINASI

Memberikan makanan yg daya alergeniknya rendah

Diet eliminasi tunggal
1 jenis makanan
Diet eliminasi ganda
2 jenis makanan
Diet eliminasi ekstensif
7 10 hari

Cara pemberian berdasarkan riwayat diet dan hasil tes kulit

0 3 bulan susu formula

3 6 bulan susu formula + serelalia
6 bln 2 th susu formula + serealia + vitamin - mineral
buah, daging
Gejala alergi
hindari pemakaian bahan tersebut dan cari pengganti
nilai gizi sama
3 12 tahun diberikan 3 kelompok BM :
bahan pokok, lauk pauk, sayuran, buah, bumbu

1 minggu (timbul gejala)

Tidak timbul reaksi, diberikan kombinasi ketiga gabungan diet

Ditambahkan tahap kedua yg lebih kuat alergeniknya,
Bila ada gejala alergi, maka tambahan makanan dipastikan
sebagai penyebab alergi

Tes diet dilakukan hati-hati dan diikuti terus,

perlu penambahan vitamin dan mineral bila tes dalam waktu
lama.

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Oral Challenge Test

Oral Challenge Test

LANGKAH KE EMPAT : lakukan evaluasi dengan cermat
berbagai gangguan yang ada dan cermati berbagai faktor
yang berpengaruh , biasanya akan membaik secara
bersamaan
LANGKAH KE LIMA : Bila ingin mengetahui penyebabnya
lakukan provokasi satu persatu makanan yang dicurigai
mulai dari daftar makanan step 2 terus ke high risk
intervention.
LANGKAH KE ENAM : lakukan diet pemeliharaan
(maintenance dietary) dengan melakukan tahapan dan
jenis khusus tidap harinya.

Program Intervensi Diet atau Modifikasi Eliminasi

Provokasi Makanan Terbuka atau Challenge test
LANGKAH PERTAMA : identifikasi berbagai gangguan
yang ada pada tubuh anda dan anak anda
LANGKAH KE DUA : identifikasi minimal satu gejala yang
ada dalam gangguan fungsi saluran cerna yang selama ini
kadang tidak disadari
LANGKAH KE TIGA : Lakukan program intervensi diet atau
eliminasi provokasi atau Challenge test dengan hanya
mengkonsumsi makanan yang relatif aman dan
menghindari beberapa makanan yang dicurigai sebagai
penyebab selama 3 minggu.

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READINGFOODLABELS

TERAPI DIET
DIET HIPOALERGI
Menghindari makanan yg diduga
sbg alergen beserta produkproduknya.
diganti dg bahan lain yg
mempunyai nilai gizi sama

Syarat diet sama dengan dalam

keadaan normal dan disesuaikan
dengan usia penderita.

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DIET DESENSITISASI
Yaitu penurunan kepekaan
seseorang dengan pemberian
makanan sumber alergen
secara bertahap.

Different names for some food ingredients appear below:

Milk proteins:
Casein, caseinates, rennet casein
Lactalbumin, lactalbumin phosphate, lactoglobulin, lactulose,
condensed, dry, evaporated, milk from goats or other
animals, low-fat, malted, milkfat, non-fat, powder, protein,
skimmed, solids and wholes.

Diperoleh tingkat toleransi yang

aman terhadap alergen
tersebut.

Egg proteins:
Albumin (also spelled albumen)
Meringue or meringue powder
These items also may include egg protein: artificial flavors;
lecithin; macaroni; marzipan;marshmallows; nougat, and
pasta. Read the label of these products very carefully.
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READINGFOODLABELS

Food Allergy Diagnosis

Skin prick testing
Peanuts :
Artificial nuts, beer nuts, ground nuts, mixed nuts, monkey
nuts, nut pieces
Cold pressed, expelled or extruded peanut oil or arachis oil
Mandelonas
Peanut butter, peanut flour
These items may include peanut protein: African, Chinese,
Indonesian, Mexican, Thai and Vietnamese dishes; baked
goods; candy; chili; egg rolls; enchilada sauce; flavoring;
marzipan; nougat, and sunflower seeds.

The skin prick test is a

good method to rule out
a food allergy to egg,
milk, peanuts, fish, fruit
and vegetable in
children. But a positive
result may need to be
confirmed with a
challenge test.

Hidden food ingredients in ready made food products!

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Food Allergy Diagnosis

What about food Additives?

Sulfur-based preservatives
Sulfites
Aspartame (a sweetener)- PKU
Monosodium glutamate
FD&C Yelow #5 (Tartrazine)

Blood tests / RAST-Radio Immunodiffusion test

The test measures the
amount of IgE antibody
in the blood.

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If antidose is given..
epinephrine
antihistamines

sodium cromolyn

Picture credit: used with permission from Dr. Gary E. Kaiser

http://www.cat.cc.md.us/courses/bio141/lecguide/index.html

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Managing Food Allergies

and Food Intolerance

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