Food Allergies

(DIET 614)

Dr. Stephen T. Engmann

1
Recommended Text
 Nelms M, Sucher KP, Lacey K, Roth SL.
Nutrition Therapy and Pathophysiology. 3rd
Editio. Wadsworth Cengage Learning.
Boston, MA 02210 USA: Cengage Learning;
2016
 Pages 185 - 188

2
Learning Outcomes
 By the end of this topic students should be able to:
Define a food allergy and differentiate it from food intolerance
Describe the types of food allergy
Understand how allergic reaction work(Pathophysiology)
List the sign and symptoms of food allergy
Identify common food allergen
Describe the diagnosis and management of food allergy
Describe the Nutritional Problems of food allergy

3
Definitions
 Food allergy is an abnormal response to a
food triggered by the body’s immune system.
 Allergic reactions to food can cause serious
illness or even death.

4
Definitions
 A food intolerance is an abnormal reaction to
food that is not immune mediated—for
example, lactose intolerance.
 Food allergy is different with food intolerance
although both can show similar symptoms.

5
Types of Food Allergy

 IgE Mediated Food Allergy

6
Epidemiology
As many as 15 million people have food allergies.
An estimated 9 million, or 4%, of adults have food allergies.
Nearly 6 million or 8% of children have food allergies with
young children affected most.
According to a study released in 2013 by the Centers for
Disease Control and Prevention, food allergies among
children increased approximately 50% between 1997 and
2011. (Food Allergy Research & Education)

7
Epidemiology
 The incidence of food allergy in children
under the age of 18 has increased by
approximately 18% over the past 10 years.

8
Epidemiology
 The American Academy of Allergy, Asthma &
Immunology states that approximately 3 million adults in the
United States report allergy to peanuts and tree nuts
(almonds, Brazil nuts, hazelnuts, and walnuts).
 Another 6 million reports an allergy to fish and shellfish.
 The most common food allergens in infants and children are
cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish, and
shellfish.

9
Epidemiology
 Food allergies represent 5% to almost 50%
of allergic reactions in Africa
 National data on food allergy
prevalence in Ghana is lacking
 Self-reported FA and sensitization is
estimated at 11% and 5% of schoolchildren
repspectively.(Obeng et al, 2011)

10
Pathophysiology – IgE Mediated

11
Pathophysiology – IgE Mediated
 An immediate allergic reaction involves two actions of the
immune system:
1.The immune system produces immunoglobulin E (IgE) – a
type of protein that works against a specific food – antibody.
2.IgE attaches basophils (white blood cells) and to mast
cells – cells found in all body tissues. The typical sites of
allergic reactions include nose, throat, lungs, skin and GI
tract.

12
13
Pathophysiology
 A person cannot have an allergic reaction to
a substance that he or she has never come
across in most cases.
 The immunologic process is in 2 phases
1. Sensitization
2. Allergic reaction after Re-exposure to
allergen

14
Sensitization
 Food allergens are proteins within the food that
enter the body after the food is digested.
 When allergens enter the body, antigen presenting
cells (immune cells that capture incoming
substances and present them to other immune
cells) in the body, capture and present them to
immune cells, particularly T cells (in a similar
manner as if the allergen was a foreign invading
microbe).
15
Sensitization
 Through a number of immune interactions
between T cells and B cells, B cells produce
allergen-specific IgE antibodies.
 Once released into the blood, IgE binds to
mast cells (the major allergy immune cell), as
well as other immune cells such as
basophils.

16
Allergic reaction after Re-
exposure to allergen
 Not all individuals who are sensitised will
develop an allergic reaction on re-exposure
to the allergen.
 It is possible for an individual to go their
whole life carrying allergen-specific IgE
bound mast cells without ever experiencing
an allergic reaction

17
Allergic reaction after Re-
exposure to allergen
 Upon re-exposure to the allergen, binding of
the allergen to IgE on mast cells can initiate
an aggressive and immediate immune
response.
 This results in their rapid degranulation and
the release of inflammatory compounds,
including histamine, which contribute to local
inflammation and the symptoms associated
with allergy. 18
Allergic reaction after Re-
exposure to allergen
 An allergic reaction to food can take place
within few minutes to an hour.
 Histamine causes constriction of the airways,
which causes difficulty in breathing; blood
vessel dilation, which lowers blood pressure;
and fluid leakage from the bloodstream to
tissues, which results in shock, hives, and GI
symptoms such as abdominal pain, cramps,
vomiting, and diarrhea 19
20
Pathophysiology – Cell Mediated

21
22
Digestive Tract
Diarrhea
Constipation
Nausea and Vomiting
Abdominal bloating and distension
Abdominal pain
Indigestion (heartburn)
Belching

23
Respiratory Tract / EENT
Seasonal or perennial rhinitis
Rhinorrhea (runny nose)
Allergic conjunctivitis (itchy, watery, reddened
eyes)
Serous otitis media (earache with effusion)
Asthma
Laryngeal oedema (throat tightening due to
swelling of tissues)
24
Nervous System
Migraine or headaches
Restlessness
Hyperactivity
Lack of concentration
Irritability
Dizziness

25
Anaphylaxis
Severe reaction of rapid onset, involving most
organ systems, which results in circulatory
collapse and drop in blood pressure
In the most extreme cases the reaction
progresses to anaphylactic shock with
cardiovascular collapse
This can be fatal

26
Anaphylaxis
 These systemic reactions can vary
from milder symptoms of nausea, generalized
urticaria, or angioedema to severe
and life-threatening hypotension, shock, and
airway edema.

27
Anaphylaxis is an Emergency
 Treatment of anaphylaxis should include
assessment and management of the ABCs (airway,
breathing, and circulation), with intubation, if
necessary,
 IV access, and fluid resuscitation at usually 500-
1000 mls) as soon as possible.
 Subcutaneous or intramuscular injection of 0.3 to
0.5 mL of 1:1000 solution of epinephrine should be
given as quickly as possible and repeated in 10 to
15 minutes if needed.
28
 Antihistamines, steroids (if severe), and
bronchodilators may be required as well.
 Anyone with an anaphylactic reaction should
be observed in a hospital setting for 12 to 24
hours, as the symptoms can recur.

29
30
Diagnosis
Diagnosis of allergy is based on a combination of:
Clinical history and physical examination to rule out
other causes of symptoms.
A thorough diet history and use of a food
diary will provide invaluable information for diagnosis
Skin tests
Identifying the type of IgE that is fixed to the skin mast
cell.
For example: scratch test/ Skin prick test.
31
Blood tests
 Analyze FBC, TFT, and Urine R/E
 RAST (radioallergosorbent test) or ELISA (
enzyme-linked immunosorbent assay).
 These tests measure the presence of
food-specific IgE in blood and the total IgE
level in blood

32
Skin tests
 A liquid containing a small amount of the
suspected allergen is applied to the patient’s
forearm and then the skin is pricked using a
sterile needle.

33
Skin prick tests

34
Elimination/challenge diet testing
 A single food or a combination of suspect
foods is not consumed for 2 weeks. If the
symptoms disappear, suspect foods are
added back, one at a time, in increasing
amounts until normal levels are reached
or symptoms occur.
 Elimination/challenge tests require a
high degree of patient motivation and
compliance during the elimination phase. 35
Management of food allergy
 Symptomatic pharmacotherapy
Dietary avoidance
Hyposensitization - DNA vaccination with
allergen DNA.
Counseling: nutritional, psychological
 Immunotherapy (Emerging area of research)

36
 Desensitisation involves administration of a
particular allergen, given in gradually increasing
doses, eventually developing immunity or tolerance
to the allergen.
 In practice, the treatment can be administered as
drops, as a dissolvable tablet under the tongue, or
as an injection into the arm.
 Clinical trials for food allergy desensitisation are still
ongoing
37
38
Consumer Protections & Labeling
Food manufacturers are generally responsible about
posting alerts concerning allergen contamination and
recalling their products.
Labeling of foods containing allergens have to be
clear and consistent.
The awareness of the consumers in checking the
labels.

39
Nutrition Implications of Food
Allergies
 May result in the elimination of numerous
foods from the diet.
 Without proper guidance for nutrition
adequacy, delayed or stunted growth in
children as well as additional nutrient
deficiencies in both children and adults may
develop.

40
Nutrition Diagnosis
Common nutrition diagnoses associated with
food allergy include:
1. Inadequate food/oral beverage intake;
2. Undesirable food choices
3. Food and nutrition-related knowledge deficit
4. Disordered eating pattern
5. Poor nutrition quality of life.

41
42
THANK YOU

43