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FOOD ALLERGY

A food allergy is an adverse immune response to a food protein. They are distinct from other
adverse responses to food, such as food intolerance, pharmacological reactions, and toxinmediated reactions.
The protein in the food is the most common allergic component. These kinds of allergies occur
when the body's immune system mistakenly identifies a protein as harmful. Some proteins or
fragments of proteins are resistant to digestion and those that are not broken down in the
digestive process are tagged by the Immunoglobulin E (IgE). These tags fool the immune system
into thinking that the protein is harmful. The immune system, thinking the organism (the
individual) is under attack, triggers an allergic reaction. These reactions can range from mild to
severe. Allergic responses include dermatitis, gastrointestinal and respiratory distress, including
such life-threatening anaphylactic responses as biphasic anaphylaxis and vasodilation; these
require immediate emergency intervention. Individuals with protein allergies commonly avoid
contact with the problematic protein. Some medications may prevent, minimize or treat protein
allergy reactions. As of now there is no cure.
Treatment consists of either immunotherapy (desensitisation) or avoidance, in which the allergic
person avoids all forms of contact with the food to which they are allergic. Areas of research
include anti-IgE antibody (omalizumab, or Xolair) and specific oral tolerance induction (SOTI),
which have shown some promise for treatment of certain food allergies. People diagnosed with a
food allergy may carry an injectable form of epinephrine such as an EpiPen, or wear some form
of medical alert jewelry, or develop an emergency action plan, in accordance with their doctor.
The scope of the problem, particularly for young people, is a significant public health issue.
Classification
Food allergy is thought to develop more easily in patients with the atopic syndrome, a very
common combination of diseases: allergic rhinitis and conjunctivitis, eczema and asthma. The
syndrome has a strong inherited component; a family history of allergic diseases can be
indicative of the atopic syndrome.
Conditions caused by food allergies are classified into 3 groups according to the mechanism of
the allergic response:
1. IgE-mediated (classic):

Type-I reaksi hipersensitif (gejala yang dijelaskan di atas)


Sindrom alergi oral

2. IgE dan/atai non-IgE-mediated:

Allergic eosinophilic esphagitis

Allergic eosinophilic gastritis

Allergic eosinophilic gastroenteritis

3. Non-IgE mediated:

Food protein-induced Enterocolitis syndrome (FPIES)


Food protein proctocolitis/proctitis

Food protein-induced enteropathy. An important example is Celiac disease, which is an


adverse immune response to the protein gluten.

Milk-soy protein intolerance (MSPI) is a non-medical term used to describe a non-IgE


mediated allergic response to milk and/or soy protein during infancy and early childhood.
Symptoms of MSPI are usually attributable to food protein proctocolitis or FPIES.

Heiner syndrome lung disease due to formation of milk protein/IgG antibody immune
complexes (milk precipitins) in the blood stream after it is absorbed from the GI tract.
The lung disease commonly causes bleeding into the lungs and results in pulmonary
hemosiderosis.

Signs and symptoms


Classic immunoglobulin-E (IgE)-mediated food allergies are classified as type-I immediate
Hypersensitivity reaction. These allergic reactions have an acute onset (from seconds to one
hour) and may include:

Hives
Itching of mouth, lips, tongue, throat, eyes, skin, or other areas

Swelling (angioedema) of lips, tongue, eyelids, or the whole face

Difficulty swallowing

Runny or congested nose

Hoarse voice

Wheezing and/or shortness of breath

Nausea

Vomiting

Abdominal pain and/or stomach cramps

Lightheadedness

Fainting

Symptoms of allergies vary from person to person. The amount of food needed to trigger a
reaction also varies from person to person.
Cardiopulmonary
Serious danger regarding allergies can begin when the respiratory tract or blood circulation is
affected. The latter can be indicated through wheezing and cyanosis. Poor blood circulation leads
to a weak pulse, pale skin, and fainting.
A severe case of an allergic reaction, caused by symptoms affecting the respiratory tract and
blood circulation, is called anaphylaxis. When symptoms are shown where breathing is impaired
and circulation is affected, the person is said to be in anaphylactic shock. Anaphylaxis occurs
when IgE Antibodies are involved, and areas of the body that are not in direct contact with the
food become affected and show symptoms. This occurs because no nutrients are circulated
throughout the body, causing the widening of blood vessels. This vasodilation causes blood
pressure to decrease, which leads to the loss of consciousness. Those with asthma or an allergy to
peanuts, tree nuts, or seafood are at greater risk for anaphylaxis.
Common Allergies
One of the most common food allergies is a sensitivity to peanuts, a member of the bean family.
Peanut allergies may be severe, but children with peanut allergies sometimes outgrow them. Tree
nuts, including pecans, pistachios, pine nuts, and walnuts, are also common allergens. Sufferers
may be sensitive to one particular tree nut or to many different tree nuts. Also seeds, including
sesame seeds and poppy seeds, contain oils where protein is present, which may elicit an allergic
reaction.
Egg allergies affect about one in fifty children but are frequently outgrown by children when
they reach age five. Typically the sensitivity is to proteins in the white, rather than the yolk.
Milk, from cows, goats or sheep, is another common food allergen, and many sufferers are also
unable to tolerate dairy products such as cheese. A very small portion of children with a milk
allergy, roughly ten percent, will have a reaction to beef. Beef contains a small amount of protein
that is present in cow's milk.
Other foods containing allergenic proteins include soy, wheat, fish, shellfish, fruits, vegetables,
spices, synthetic and natural colors, and chemical additives.
Although sensitivity levels vary by country, the most common food allergies are allergies to
milk, eggs, peanuts, tree nuts, seafood, shellfish, soy and wheat. These are often referred to as
"the big eight." Allergies to seeds especially sesame seem to be increasing in many
countries. An example of allergies more common to a particular region is the surplus rice
allergies in East Asia where rice forms a large part of the diet.

Cross reactivity
Some children who are allergic to cow's milk protein also show a cross sensitivity to soy-based
products. There are infant formulas in which the milk and soy proteins are degraded so when
taken by an infant, their immune system does not recognize the allergen and they can safely
consume the product. Hypoallergenic infant formulas can be based on hydrolyzed proteins,
which are proteins partially predigested in a less antigenic form. Other formulas, based on free
amino acids, are the least antigenic and provide complete nutrition support in severe forms of
milk allergy.
People with latex allergy often also develop allergies to bananas, kiwi, avocados, and some other
foods.
Prevention
According to a report issued by the American Academy of Pediatrics, "There is evidence that
breastfeeding for at least 4 months, compared with feeding infants formula made with intact cow
milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and
wheezing in early childhood."
In order to avoid an allergic reaction, a strict diet can be followed. It is difficult to determine the
amount of allergenic food required to elicit a reaction, so complete avoidance should be
attempted unless otherwise suggested by a qualified medical professional. In some cases,
hypersensitive reactions can be triggered by exposures to allergens though skin contact,
inhalation, kissing, participation in sports, blood transfusions, cosmetics, and alcohol.
When avoiding certain foods in order to lessen the risk of reaction, it can be hard to maintain the
proper amounts of nutrients. Some allergens are also common sources of vitamins and minerals,
as well as macronutrients such as fat and protein; healthcare providers will often suggest
alternate food sources of essential vitamins and minerals which are less allergenic.
Treatment
The mainstay of treatment for food allergy is avoidance of the foods that have been identified as
allergens. For people who are extremely sensitive, this may involve the total avoidance of any
exposure with the allergen, including touching or inhaling the problematic food as well as
touching any surfaces that may have come into contact with it.
If the food is accidentally ingested and a systemic reaction (anaphylaxis) occurs, then
epinephrine should be used. It is possible that a second dose of epinephrine may be required for
severe reactions.
There are treatments for an allergic reaction. Among the first time the reaction occurs, it is most
beneficial to take the person to the emergency room, where proper action may be taken. Other
treatments include: epinephrine, antihistamines, and steroids.

Epinephrine
Epinephrine, also known as adrenaline, is a common medication used to treat allergic reactions.
Epinephrine reverses the allergic reaction by improving blood circulation. This is done by
tightening blood vessels in order to increase the heart beat and circulation to bodily organs.
Epinephrine is produced naturally in the body. It is produced during "flight-or-fight" response.
When a person is presented with a dangerous situation, the adrenal gland is triggered to release
adrenaline; this gives the person an increased heart rate and more energy to try to fight off the
danger being imposed on the individual. Epinephrine is also prescribed by a physician in a form
that is self-injectable. This is what is called an epi-pen.
Antihistamines
Antihistamines are also used to treat allergic reactions. Antihistamines block the action of
histamine, which causes blood vessels to dilate and become leaky to plasma proteins. Histamine
also causes itchiness by acting on sensory nerve terminals. The most common antihistamine
given for food allergies is diphenhydramine, also known as Benedryl. Antihistamines relieve
symptoms. When it comes to dealing with anaphylaxis, however, they do not completely
improve the dangerous symptoms that affect breathing.
Steroids
Steroids are used to calm down the immune system cells that are attacked by the chemicals
released during an allergic reaction. This form of treatment in the form of a nasal spray should
not be used to treat anaphylaxis, for it only relieves symptoms in the area in which the steroid is
in contact. Another reason steroids should not be used to treat anaphylaxis is due to the long
amount of time it takes to reduce inflammation and start to work. Steroids can also be taken
orally or through injection. By taking a steroid in these manners, every part of the body can be
reached and treated, but a long time is usually needed for these to take effect.
Desensitization, also known as, Oral Immunotherapy
For food allergy, desensitization can be achieved through oral immunotherapy. While not a cure,
this program enables food allergic children and adults to consume foods that they were allergic to
previously, without any allergic reaction.
Traditional Chinese Medicine
As of early 2012, phase II clinical trials for human efficacy have gotten underway for a formula
called FAHF-2 (food allergy herbal formula 2). This formula is based on a long-used Traditional
Chinese Medicine formula for parasite infection. In early clinical trials, it has been found to
completely block anaphylaxis in mouse models.

Epidemiology
The most common food allergens include peanuts, milk, eggs, tree nuts, fish, shellfish, soy, and
wheat these foods account for about 90% of all allergic reactions. The most common food
allergies in adults are shellfish, peanuts, tree nuts, fish, and egg. The most common food allergies
in children are milk, eggs, peanuts, and tree nuts.
Six to eight percent of children under the age of three have food allergies and nearly four percent
of adults have food allergies.
For reasons that are not entirely understood, the diagnosis of food allergies has apparently
become more common in Western nations in recent times. In the United States, food allergy
affects as many as 5% of infants less than three years of age and 3% to 4% of adults. There is a
similar prevalence in Canada.
Seventy-five percent of children who have allergies to milk protein are able to tolerate baked-in
milk products, i.e., muffins, cookies, cake.
About 50% of children with allergies to milk, egg, soy, and wheat will outgrow their allergy by
the age of 6. Those that are still allergic by the age of 12 or so have less than an 8% chance of
outgrowing the allergy.
Peanut and tree nut allergies are less likely to be outgrown, although evidence now shows that
about 20% of those with peanut allergies and 9% of those with tree nut allergies will outgrow
them.
In Central Europe, celery allergy is more common. In Japan, allergy to buckwheat flour, used for
soba noodles, is more common.
Meat allergy is extremely rare in the general population, but a geographic cluster of people
allergic to meat has been observed in Sydney, Australia. There appears to be a possible
association between localised reaction to tick bite and the development of meat allergy.
Fruit allergies exist, such as to apples, peaches, pears, jackfruit, strawberries, etc.This is
suspected to be associated with Ragweed Pollen allergy but could be due to other reasons
Corn allergy may also be prevalent in many populations, although it may be difficult to
recognize in areas such as the United States and Canada where corn derivatives are common in
the food supply.
Protein allergies or intolerance of seeds, nuts, meat, and milk are especially common among
children.