food intolerence

Dr.Azad A Haleem AL.MezoriDCH, FIBMS

Lecturer University Of DuhokColleg of Medicine

Pediatrics Department2016

azad82d@gmail.com

Food Intolerance

Introduction

• Food-hypersensitivity reactions can either involve:• The immune system in which case it’s called a

‘food allergy’ or• It does not involve the immune system and is

called ‘food intolerance’. • A food intolerance is sometimes confused with or

mislabeled as a food allergy.

Food Allergy • A food allergy is an abnormal

reaction of the body's immune system to a particular food.

• Food allergy, reactions caused by the immune system, either IgE antibody mediated or delayed non-IgE mediated allergy.

• Affects multiple body systems: GI Respiratory Skin Cardiovascular• Exposure can cause serious

problems or death.

Common food allergies• About 90% of food allergies are

caused by seven foods:o cow’s milko hen’s eggso soybeanso peanutso tree nuts – almond, brazil, cashew

and so ono wheato fish and shellfish.• The remaining 10% of allergies are

caused by a wide variety of other foods.

Intolerance vs. Allergy

• Food Intolerance– Reaction to the chemicals in food– No immune system response– No serious (life-threatening) side-effects • Bloating, gas, abdominal discomfort.

What is food intolerance?• Food intolerance, also known as non-IgE mediated food

hypersensitivity or non-allergic food hypersensitivity, • refers to difficulty in digesting certain foods. • It is important to note that food intolerance is different

from food allergy.• Food intolerances involve the digestive system. • Food allergies involve the immune system.

• When ingestion of a particular food or food additive causes unpleasant symptoms, a person is said to be intolerant to that food.

• Symptoms occur as a result of either:poor absorption from the intestine into the

bloodstream or less commonly by the release of chemicals

within the body occurring as a result of contact of the food with the body.

What is food intolerance?

Symptoms of food intolerance• It can be difficult to determine whether the patient has a food

intolerance or an allergy because the signs and symptoms often overlap.

• when it is an allergy, even small amounts result in symptoms, as may be the case with peanuts. Whereas, with food intolerance, tiny amounts will usually have no effect.

• The symptoms of food intolerance generally take longer to emerge, compared to food allergies.

• onset typically occurs several hours after ingesting the offending food or compound and may persist for several hours or days.

• According to the Australian NSW Food Authority, the following are the most common symptoms of food intolerance:

• Bloating• Migraines• Headache• Cough• Runny nose• Stomach ache• Irritable bowel• fatigue.

Causes of food intolerance• There are many different types of food intolerances, including: Enzymatic - lactose intolerance. Intolerance to a protein. Gluten (Celiac) Pharmacologic reactions. • Pharmacological intolerances involve reactions to certain chemical

naturally occurring foods such as: Histamine containing foods such as cheese food additives, especially the benzoate and sulphite preservatives

and monosodium gluatamate. caffeine – in coffee, tea, and chocolates. salicylate and glutamate Toxin

Absence of an enzyme• Nearly all foods require an enzyme for proper digestion. • According to the British Allergy Foundation, enzyme

deficiencies are a common cause of food intolerance.• The most common type of enzymatic food intolerance is

lactose intolerance, which occurs because these individuals have either too little or no lactase

• lactose intolerant: it can cause spasm, stomachache, bloating, diarrhea, and gas.

• Researchers from Mary Bridge Children's Hospital and Health Center USA , found that fructose intolerance is common in children with recurrent or functional abdominal pain.

Pharmacologic reactions. Food chemical Dietary sources Proposed mechanism of gastrointestinal

symptom provocation

SalicylatesCoffee, tea, green apples, banana, lemon, plums, grapes, grapefruit, tomato, carrots, cucumber, peas, herbs and spices

Stimulates mast cells to overproduce leukotriene metabolites which in turn may lead to pro-inflammatory reactions and smooth muscle contraction

Amines (e.g. histamine)

cheese, cured and processed meat products, tinned fish

Low amine oxidase activity in some individuals limits detoxification of dietary histamine and increased levels of histamine can increase smooth muscle contractions

Glutamates Tomato, cheese, stock cubes, yeast extract

Unknown but exclusion of dietary additive excitotoxins (including MSG) in IBS resolved >30% of symptoms in 84% of patients

Caffeine Coffee, tea, chocolate, cola drinks, caffeine drinks

Stimulates central nervous system and increases gastric juice secretion and colonic motor activity possibly via gastrointestinal neuroendocrine hormones (e.g. cholecystokinin, exorphin, gastrin or motilin) but this is unknown

Diagnosing food intolerance• Investigations may include blood and faecal tests, endoscopy

and/or radiological imaging to rule out any organic disease. • It is not easy to determine whether somebody has a food

intolerance or allergy because the signs and symptoms often overlap.

• The doctor may recommend a skin test and/or a blood test to rule out food allergy.

• Apart from lactose intolerance and celiac disease, there is no accurate, reliable, and validated test to identify food intolerance.

Food Exclusion, Symptom Improvement and Dietary Challenge

• The best diagnostic tool is an exclusion diet, also known as an elimination or diagnostic diet.

• Patients are advised to keep a diary and write down which foods are eaten, what the symptoms were like, and when they appeared.

• The data in the diary can help a dietician or doctor identify which foods are causing adverse reactions, and what steps to take.

• Exclusion diets are extremely useful in isolating the culprit foods.

• In a typical exclusion diet, the suspected food is removed from the diet for a set period, usually between 2 weeks and 2 months.

• If during this period the adverse reactions resolve, it becomes more likely that the culprit has been found.

• This can be further confirmed if it is then reintroduced and symptoms return.

• It is important to emphasise that elimination diets must only be undertaken for a short term, under strict medical supervision.

• Prolonged restricted diets can lead to problems with adequate nutrition, particularly in children.

Testing for Food Intolerance ????

By taking a small, finger-prick blood sample, it ispossible to measure food-specific IgG antibodies in your blood. Your IgG antibodyreadings are shown in your personal Food Intolerance Test results.

Treatment

• The best current treatment for food intolerance is to either:

• avoid certain foods or • eat them less often and in smaller amounts,

as well as • taking supplements that may help digestion.

Tolerance can improve• Some people find that if they stay off the

specific food for a while, they have no reaction when eating it again - this is known as tolerance.

• Maintaining tolerance is often a question of knowing how long to abstain, and how much of it to eat when it is being reintroduced.

THANKS FOR YOUR ATTENTION