Alergi Makanan

Nutrition in Infancy & Childhood

Masalah Makan pada bayi dan anak
Module 3 Section 3

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 Definisi alergi makanan

• Respon Immun tubuh yang

tidak normal setelah
mengkonsumsi makanan
tertentu

– Respon dapat berupa IgE yang

menyebabkan atopik – gejala
serangan cepat (type I)
– Respon non-IgE – gejala
serangan lambat(type II or III)

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 Jenis –jenis alergi

Cepat Sedang Lambat

Jenis reaksi
Type I Type III Type IV

Immun T lymfosit
Mediator IgE
Yang kompleks

Gejala serangan < 1 jam 4-12 jam 1-3 hari

Perdarahan pada
Urticaria, atopic
Saluran cerna,
dermatitis, Chronic
colitis,
Gejala utama muntah, diare enteropathy,
vasculitis,
asthma, malabsorption
exudative
rhinitis
enteropathy

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 IgE-mediated Response

• Serangan hipersensitive yang

cepat
• Terikatnya antigen dengan
IgE specific, yang
meningkatkan pembentukan
antibodi
• Terikatnya antigen
menyebabkan terjadinya
perpecahan sel dan keluarnya
zat kimia yang menyebabkan
radang
• Gejala timbul < 2 jam setelah
makan
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 Apakah intoleran makanan ... allergi?

• Mekanisme Non-immunologic
• Reaksi sistem pencernaan
terhadap makanan tertentu
• Terjadi karena defisiensi
enzim (i.e.lactase)
• Reaksi berlebih dari beberapa
amino biogenik pada makanan
• Hal lain yang tidak diketahui

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 Mekanisme reaksi merugikan dari makanan

Adverse
Toxic Immune = allergy
reactions

Non-toxic IgE Non-IgE

Non-immune = food intolerance

Enzymatic Pharmacologic Undetermined

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Alergi atau hipersensitivitas tipe I adalah
kegagalan kekebalan tubuh di mana tubuh
seseorang menjadi hipersensitif dalam bereaksi
secara imunologi terhadap bahan-bahan yang
umumnya nonimunogenik. Dengan kata lain,
tubuh manusia bereaksi berlebihan terhadap
lingkungan atau bahan-bahan yang oleh tubuh
dianggap asing dan berbahaya, padahal
sebenarnya tidak. Bahan-bahan yang
menyebabkan hipersensitivitas tersebut disebut
alergen.

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 Atopic diseases are a widespread problem in
child health...

...and have significantly increased over the last

three decades
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 Frekuensi alergi makanan
pada anak-anak

• Alergi makanan – manifestasi awal dari atopi

• 20-30% terjadi pada BATITA
• Akan berkurang dengan bertambahnya umur
• Meningkat karena faktor lingkungan

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 Factor-faktor pendorong alergi
Sensitization

• Riwayat keluarga
• Peningkatan permeabilitas
usus
• Belum matangnya sistem
imun
• Penyapihan terlalu dini,
eksposur dini terhadap
alergen
• Status kurang gizi

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 Sensitization is the “dangerous” bottle
in the nursery

• Initial exposure to cow’s milk based

formula in the nursery

• IgE production stimulated even by a “single

drop” of milk protein in formula
• IgE for milk protein kept in immune
memory lasting 5 to 12 months.

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 Allergy Reaction

• Repeated contact with

allergen.
• Formation of IgE
antibodies
• Subsequent contact with
allergen
• Release of histamine
• Symptoms

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 Antigens & Allergens

Antigens Food Allergens

• immune response • immune hyper-response

• protein in nature • protein in nature
• presence of • presence of epitopes
epitopes • allergy
• sensitization

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Factors promoting allergy...
Family History
Allergic Risk in Newborns

Neither parent allergic One parent allergic Both parents allergic

8-15% 20-40% 40-60%

Both parents allergic

A sibling allergic
same symptoms
25-30%
60-80% BG/MGL
Factors promoting allergy...

Immaturity of the GI tract

• Permeabilitas usus
terhadap molekul besar
sangat tinggi selama 3
bulan pertama
• Meningkat dengan
adanya gastroenteritis

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Factors promoting allergy...

Immunological Immaturity

• immature immune system

- sIgA yang kurang
- defective antigen
processing

• Terjadi pada usia awal

kehidupan

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Factors promoting allergy...

Vulnerability caused by illness,infections &

malnutrition status

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 Makanan penyebab alergi

• Proteins > BM 10,000-

40,000 daltons

• Alergen pada bayi

berasal dari susu sapi
atau protein kedele

• Pada anak-anak :telur,

kacang, ikan & gandum

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Food allergens

Protein susu sapi

• Mengandung ~ 30 jenis protein berpotensi alergi
• Sebagian besar anak-anak sensitif terhadap
protein :
– -lactoglobulin 60-80%
– -lactalbumin & caseins ~40%
– Protein lain ~25%
• Pemanasan susu dapat mengurangi antigen tapi
tidak menjamin hilangnya alergen
• Prevalensi ~2-5%
• Alergi protein soya ~30-50%

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Food allergens

Proteins kedelai

• Diduga cenderung kurang

menimbulkan resiko alergi
daripada protein susu sapi

– frekuensi alergi protein susu

sapi= susu kedele

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 Makanan penyebab alergi

Telur: putih telur

Ikan & kerang
keju, Coklat
Daging: sapi,ayam
kacang2an: buncis,
kedele, kacang tanah
sayuran: tomat,kentang
Buah: jeruk, berries

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Most frequent allergens during the first
year of life

Qtr(1st yr) cow’s milk egg fish others

1st 45 0 0
2nd 30 8 7 2
3rd 2 33 18 3
4th 0 24 10 3

Total 77 65 35 8

% of total* 97.5 64.4 47.9 7.0

Data from Crespo,JF, Martin Esteban M., Blanco C, J Allergy Clin Immunology
1992; 89; 19292
* % of all cases with known onset of symptoms related to the respective food.

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 Tanda klinis alergi makanan

Kelainan pada kulit Anaphylactic

shock  jarang
bayi Dapat berakibat kematian

Gejala pada
saluran cerna

Gejala pada saluran

pernafasan

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Clinical Signs of Food Allergy

Cutaneous - Skin

• rashes
• dermatitis
• urticaria
• atopic eczema

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Clinical Signs of Food Allergy

Gastrointestinal Symptoms

The entire digestive tract

may be affected
- diarrhea, loose stools
- vomiting
- stomach cramps, colic
- appears in the first few
months of life
- disappears after age
2-3 yrs.

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Clinical Signs of Food Allergy

Infantile Colic

• excessive crying in
healthy infants in
evening
• common during the
first weeks up to
4-5 months

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Clinical Signs of Food Allergy

Respiratory Symptoms

• older children
• sneezing
• laryngitis
• asthma
• chronic bronchitis

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 Clinical Signs of Food Allergy

• Cow’s milk allergy

– transient
– often disappears before 1-2
years of age
– almost always disappears
before age 6
– many though develop other
allergies &/or asthma

• Egg, fish, peanut allergy:

life-long

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Dietary Measures for Allergy Prevention

• Breast feeding
– exclusive
– exclusion of food
allergens in
maternal diet
– avoidance of cow’s
milk protein but
with calcium
supplementation

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Dietary Measures for Allergy Prevention

• Hypoallergenic Formulas
– moderate protein
hydrolysis
– peptides molecular weight
< 5,000 -10,000 daltons
– studies show reduction of
allergic manifestations up
to 5 years of age

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Dietary Measures for Allergy Prevention

• Weaning
– if breastfeeding, wean
at late stage
– give after 6 months
– after 9 months for
fish, eggs & peanuts
– no new food after
episode of acute
gastroenteritis

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Strategy for Prevention in Children at Risk for Allergy

Elimination of pets, mites & passive smoking

•FU formulas
•Breast Milk (HA preferably)
&/or
•Diversification Normal Diet
•HA formulas of diet w/o
(HA exclusively) egg, fish or
peanut

0 6 12 18 24 30 36mo.

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 Treatment of Allergy

• food allergy - total & sustained

elimination of causative food
• oral challenge test with medical
supervision
• CMPA - complete elimination of
CMP
– dairy products, butter & cheese
– beef (cross allergy)
– margarins
– some medications & soap products
– most lactose products have
traces of CMP

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