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ADVERSE REACTION TO FOODS

Hertanto W Subagio

ADVERSE REACTION TO FOODS

Merupakan gejala/tanda yg muncul setelah mengkonsumsi makanan tertentu.

Contoh :

- sejumlah buruh pabrik muntah dan diare setelah makan siang - bayi diare setelah minum susu - gatal-gatal setelah makan sea food dst.

Klasifikasi

Toksik Non toksik

Immune mediated (alergi makanan) :

  • - Ig E mediated

  • - Non Ig E mediated

Non Immune mediated (toleransi makanan) :

  • - Enzimatik

  • - Farmakologikal

  • - Undefined

Psychological

Toksin

Berasal dari makanan

  • - jamur

  • - beberapa jenis ikan

  • - jengkol

Kontaminan

  • - bakteria: salmonella, campylobacter,

shigella

  • - virus

  • - non organik : aditif, As, Pb, etc

Non Immune Mediated ARF

Enzimatik :

Farmakologikal :

Aditif :

Enzimatik

e.g Lactose intolerance , sukrose intolerance

Laktosa yg tdk tercerna tinggal di lumen usus menimbulkan efek osmotik retensi cairan.

Laktosa mengalami proses fermentasi oleh bakteri usus, memproduksi asam organik & hidrogen.

Distensi lumen oleh gas memicu borborigmi & nyeri, serta retensi cairan menyebabkan diare

Terapi : menghindari mkn yg mengandung laktosa

Farmakologikal :

Bbrp makanan mengandung substansi yg dpt memicu langsung pelepasan sel mast & basofil /vasoaktif amin (atau prekursor lain) & neurotransmitter, shg mirip inflamasi alergi. pseudo allergies.

Contoh pada seafoods yang tidak disimpan dengan baik : memproduksi histamin like substance

Caffeine MSG : chinese restaurant syndrome

Aditif :

Beberapa aditif dpt bertindak sbg haptens, bergabung dgn protein autolog & memicu reaksi imun,

Misal :

tatrazine yellow benzoat salicylates, sulphites

Food allergy

Immunologically mediated

The most serious form of reaction to food

Its effect can be rapid, life threatening and trigerred by minute amounts of the allergen

Family history of atopic disease

Prevalence

Hard to determine Food allergy :

  • - 1 -2 % of the general population

  • - 5 – 8 % of the children

Perceived prevalence is much higher

The prevalence of non-allergic food intolerance is almost impossible to estimate because of the variability in its cause and effect.

Cause of food allergy

Results from a faulty and exaggerated response of the immune system following exposure to a foreign protein (antigen).

Normally immune system is able to distinguish between antigens that need to be destroyed and those that do not.

If learning process in developing tolerance is faulty, an abnormal respons can occur.

Common Manifestation

The most common is cutaneous ( ranging from urticaria, angiooedema, atopic dermatitis).

Gastrointestinal reactions (nausea, vomiting, pain, blood in stool) occur within 1 hour of ingestion

Contact hypersensitivity of the oropharynx

Symptoms of mild Food-Allergic Reaction

Respiratory tract:

Itchy, watery eyes, running or stuffy nose, sneezing, cough, itching or swelling of the lips, wheezing

GI tract:

abdominal cramps, nausea, vomiting, diarrhea

Skin:

urtica, eczema, itchy red rash, swelling

Symptoms sometimes progress rapidly to severe reactions

Symptoms of a Severe Food-Allergic Reaction

Respiratory

shortness of breath, difficulty swallowing, itching or swelling of the mouth or throat, change in voice

Cardiovascular

drop in blood pressure, loss of consciousness/fainting shock

Four basic type of allergic response

Type I

results from the interaction of the allergen with specific Ig E

Type II

interaction of the cell bound antigen with Ig G or Ig M

Type III

immune complex reactions (antigen- Ig G- complemen –enzyme)

Type IV

T-lymphocytes

Type I

Allergic reaction due to IgE production in response to antigen

Classic and most common Occur within minutes

IgE binds to mast cells (also eosinophils, basophils)

Degranulation triggers anaphylaxis Local: hay fever, bronchial asthma Systemic: circulatory shock

Type II

Cytotoxic/cytolytic IgG or IgM-mediated

Activation of complement pathway and effector cells (platelets, neutrophils, eosinophils, macrophages, etc)

Also immediate

Type III

Immune complex formation Occur some hours after exposure Late

Combination of Ig G and circulating antigen results in activation of the complemen system, which triggers enzyme release

Typical in the skin and bronchi

Type IV

Delayed type, T cell mediated Special subset of T H1 cell migrate to site

Recognition of antigens bound to tissue cells Activation of T H1 cells to release cytokines

Recruitment of lymphocytes, macrophages, basophils The second common form of food allergy

Allergen

Ovomukoid (telur)

Arachin, conarachin, peanut-1 (kacang)

Betalaktoglobulin (BLG), alfalaktoalbumin (ALA), bovin serum albumin (BSA), bovin gama globulin (BGG) dari susu sapi

Allergen M (ikan) dsb

Dietary management of Food Allergy

Identifying and avoiding the offending allergen

Complete exclusion is imperative

Dietary management of Food Allergy • Identifying and avoiding the offending allergen • Complete exclusion is

Dietetic guidance

All potential sources of allergen are avoided

  • - foods which must avoided

  • - foods which may need to be avoided

  • - which can safely be eaten

The effects of the exclusion diet on the intake of other nutrients and overall dietary balance are minimized

Breast Feeding

Offers some protection

Lessens the exposure to cow’ s milk protein

Contains Ig A which help to block the entry of whole proteins from the baby’s immature gut into the blood stream

Contain macrophage and other immune system which may help the infant’s immune system to mature more rapidly

Finish