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FOOD ALLERGY

Atan Baas Sinuhaji

Department of ChildHealth

School of Medicine,University Of Sumatera Utara

Medan

Adverse food Reaction Adverse food Reaction ( Food Sensitivity)( Food Sensitivity)

ImmunologicImmunologic Non ImmunologicNon Immunologic(Allergy, hypersensitivity) ( Intolerance)(Allergy, hypersensitivity) ( Intolerance)

Ig E Mediated Non Ig E MediatedIg E Mediated Non Ig E Mediated(immediated) ( Late ) (immediated) ( Late )

Early LateEarly Late(0(0--2 h) (22 h) (2--48 h)48 h)

Anaphylaxis EczemaAnaphylaxis Eczema

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Food Intolerance

Host Factor Food Factor

-Enzyme defisiency - infectious m.o

-GI disorder - toxin

-Idiosyncratic - pharmacologic

-Psychologic - contaminant

(food aversion)

HYPERSENSITIVITYHYPERSENSITIVITY

I. I. Ig E, mastcell dependent reactionIg E, mastcell dependent reaction

II. II. Antibody dependent cytotoxic responseAntibody dependent cytotoxic response

III. III. AgAg--Ab complexAb complex

IV. IV. Cell mediatedCell mediated

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CONDITIONS OF ANTIGENECITYCONDITIONS OF ANTIGENECITY

1.1. Foreigness Foreigness �������� “ non self”“ non self”

2.2. Molecular size Molecular size �������� 10.00010.000

-- retained longer in the hostretained longer in the host

3. 3. Internal molecular complexity Internal molecular complexity �������� epitopeepitope

4. 4. SolubilitySolubility

5.5. Others : forms, dose, routes, ajuvants, Others : forms, dose, routes, ajuvants, genetic of the hostgenetic of the host

AntigenAntigen

Immune responseImmune response

ProtectionProtection InjuryInjury

ImmunogenImmunogen AllergenAllergen

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HypersensitivityHypersensitivity

Immune deviation Immune deviation

( Genetic predisposition)( Genetic predisposition)

Ig GIg G Th 1 Th 1 Th 2Th 2 Ig E Ig E

Defense of GI TractDefense of GI Tract

�� Non immunologicNon immunologic

�� ImmunologicImmunologic

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Defense of GI TractDefense of GI Tract

Non immunologicNon immunologic

�� IntraluminalIntraluminal

�� Gastric acidityGastric acidity

�� Gastric enzymesGastric enzymes

�� Pancreatic enzymesPancreatic enzymes

�� PeristalsisPeristalsis

�� Probiotic floraProbiotic flora

�� MucosalMucosal

�� MucinMucin

�� EnterocyteEnterocyte

Defense of GI TractDefense of GI Tract

ImmunologicImmunologic

�� Intraepithelial TIntraepithelial T--cells (CD8)cells (CD8)

�� Lamina propria TLamina propria T--cells (CD4)cells (CD4)

�� BB--cellscells

�� GALTGALT

�� Secr. IgASecr. IgA

�� Non IgA immunoglobulinesNon IgA immunoglobulines

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GALTGALTGALTGALT

(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)

SCATTERED AGGREGATES

PEYER’S PATCHES

Food allergyFood allergy

Exposure allergenExposure allergen

Genetic predispositionGenetic predisposition

Immature Defense of GI TractImmature Defense of GI Tract

�� DevelopmentDevelopment

�� LeakyLeaky

�� InfectionInfection

�� Immunologic reactionsImmunologic reactions

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MACROMOLECULAR

ANTIGENIC

RESIDENT

BACTERIA

FOOD

VIRUS

ABSORPTION

IMMUNOLOGICALLY MEDIATED

GASTROINTESTINAL DISEASE

-CMPSE

-CELIAC DISEASE

-FOOD ALLERGY

MUCOSAL INJURY

TRANSCELLULERTRANSCELLULER

Tight

Junction

Basolateral

Membrane

Intercelluler

space

E

n

t

e

r

o

c

y

t

e

Luminal

Membrane

Basal

MembraneLamina

propia

PARACELLULERPARACELLULER

Vessel

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Symptomatology in food Symptomatology in food allergyallergy

�� DermatologicalDermatological :: eczema, urticaria, edema, eczema, urticaria, edema, conjunctivitisconjunctivitis

�� GastrointestinalGastrointestinal :: diarrhea, vomiting, colicsdiarrhea, vomiting, colics

�� RespiratoryRespiratory :: closeness, dyspnoea,closeness, dyspnoea,wheeze, cough, rhinitiswheeze, cough, rhinitis

�� NeurologicalNeurological : : migrainemigraine

�� GeneralGeneral : : growth failure, irritable,growth failure, irritable,refusal foodrefusal food

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DIAGNOSING FOOD HYPERSENSITIVITYDIAGNOSING FOOD HYPERSENSITIVITY

1. 1. HistoryHistory

2. 2. Double blind placebo controlled food Double blind placebo controlled food challenge challenge �������� GOLD STANDARDGOLD STANDARD

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HISTORY HISTORY

1. The food suspected of provoking the reaction 1. The food suspected of provoking the reaction and the quantity ingestedand the quantity ingested

2. The time interval between ingestion and the 2. The time interval between ingestion and the development of symptomdevelopment of symptom

3. The type of symptoms elicited by the ingestion3. The type of symptoms elicited by the ingestion

4. Whether ingesting the suspected food 4. Whether ingesting the suspected food produced similar symptoms on other occasionproduced similar symptoms on other occasion

5. Whether other inciting factors,such us 5. Whether other inciting factors,such us exercise,are necessaryexercise,are necessary

6. The time interval from the last reaction to the 6. The time interval from the last reaction to the foodfood

DBPCFCDBPCFC

-- Totally eliminated for 10Totally eliminated for 10--14 days14 days

-- Avoidence of medication for 12Avoidence of medication for 12--96 hours96 hours

If there is a clear history of severe If there is a clear history of severe anaphylaxis following an isolated ingestion of anaphylaxis following an isolated ingestion of a specific food and there is a positive skin a specific food and there is a positive skin test, this patient should not be challengedtest, this patient should not be challenged

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Breast milkBreast milk

Protective against allergy??Protective against allergy??

�� HypoallergenicHypoallergenic

�� Immunological factors (Immunological factors (SSIgA)IgA)

�� Infection reductionInfection reduction

�� Promotes Probiotic FloraPromotes Probiotic Flora

Solid foods introductionSolid foods introduction

avoidance solid foods till 4avoidance solid foods till 4--6 mth6 mth

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BIOTICBIOTICBIOTICBIOTIC

ANTI PRO PRE SYN (EU)

- * FOS

-* GOS ���� Breast milk

•LACTOBACILLUS

•BIFIDOBACTERIUM

DYS

IMBALANCE

* FOS : Fructooligosaccaride

GOS : Galactooligosaccaride

GUT

M.O

NON PATHOGEN PATHOGEN

ECOSYSTEM

HEALTHY

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DYSBIOTIC

IMBALANCE

M.O PATHOGEN M.O NON PATHOGEN

DISEASES

PROBIOTICPROBIOTIC

LIVE MICROORGANISMSLIVE MICROORGANISMS

SUPPLEMENTAL FOODSUPPLEMENTAL FOOD

BENEFICIALLY AFFECT THE HOSTBENEFICIALLY AFFECT THE HOST

MICROBIAL BALANCEMICROBIAL BALANCE