GOOD

AFTERNOON
LITERATURE
REVIEW

DIAGNOSIS AND
MANAGEMENT OF FOOD
ALLERGY
By
Luh Witari Indrayani

Scientific advisor
dr. Made Sudipta,Sp.T.H.T.K.L
 INTRODUCTION

Food allergy :
Collection of symptoms that affect many organs
and body systems caused by food allergies.
A reaction to a food that is essentially a
hypersensitivity reaction type I (IgE-mediated),
a cell-mediated or both.

Food allergic reaction involves three main

components:
food allergens
immunoglobulin E (IgE)
mast cells and basophils.
Literature
review

INTRODUCTION

PREVALENCE
United States : 3.5-4%, 8% in children under 3 years, 6-8%
of school-age children, and 2.5% in adults.

The tendency of increase in the prevalence of food allergies over

5 years to reach 55% per year.

Symptoms and signs : varies depending on the organ affected,

for example in the digestive system, the respiratory system or
skin.
Literature
review

INTRODUCTION

Not all adverse reactions to food is a pure allergic

reactions but many physicians or the general public use
the term food allergy to all unwanted reaction from
food, either immunological or non-immunological.

All of adverse reactions to foods and food additives

approximately 20% due to food allergies.
Literature History:
review
Hippocrates the father of
medicine was the first to describe
the food adverse reactions (adverse
food reaction) around more than
2000 years ago.

yh
Anaphylactic reaction to egg is first
described by Marcello Donati
in the XVI century.

Anaphylactic reaction to fish is first

Philipp Sachs.
described by
At the beginning of XX
century several cases of
children with eczematous rash
Literature
review

History :
In 1950 Loveless first perform
a blinded placebo-controlled
food challenges to establish
yh of food allergy
the diagnosis

In May 1976 first introduced

the use of double-blind
placebo controlled oral food
challenges, a protocol that is
currently considered the gold
standard for diagnosis of food
allergies.
 Literature
review
American Academy of Allergy and Immunology
and The National Institute of Allergy and Infections
Disease.

ADVERSE FOOD REACTIONS

TOXIC/FO
OD
POISONIN
NON TOXIC
G

IMUNOLOGIC NON IMUNOLOGIC

REACTION REACTION

PSYCHOGE FOOD
Ig E Non Ig E NIC INTOLERAN
CE
Literatur
e review

Food allergy aberrant immunological reactions

due to the entry of allergens into the body of the
mechanism of this reaction can be mediated by
IgE or non-IgE.

Food intolerance non-immunologic reaction

to food and is largely the cause of unwanted
reactions

Food poisoning occurs when foods containing

the toxin
Literatur
e review

Metabolic reactions to foods

the body can not adequately digest the substances
contained in foods

Food idiosyncrasy
Quantitative abnormal response to food
substances or adittional substances that differ in
their physiological and farmacologic effects.
 < children
US: 2% with food allergy
UK: 1,4-1,8% experienced adverse food reaction and
Adult
0.01 to 0.23% of adults are afected by adverse
reactions to food additives
2% of the adult population in the Netherlands is
afected by adverse food reactions
2,5% newborn baby cows milk in the first year of life
US and UK: Hypersensitivity reaction to eggs occurs in
Children
approximately 1.3% of children and peanut occurred in
0.5% of children
Pediatric polyclinic Cipto Mangunkusumo
Hospital: 4,6% food allergy(1987-1996)
OGY
EPIDEMIOL
literature
review

Food allergen :
Allergen class I glycoprotein with molecular weight
of 10-70 kilodalton, resistant to heat, acid and
proteolytic enzym.

Allergen class IIepitope which very unstable to

high temperature,resistant to degradable enzym,
difficult to isolate.

Cows milk : betalactoglobulin (BLG),alfalactalbumin

(ALA),bovinserumalbumin
(BSA),bovingammaglobulin(BGG)
Wheat : albumin,pseudoglobulin and euglobulin
 e
literature
review

Allergens that have been identified in

some food.
Food product Allergen
1 Milk Casein, lactoglobulin,lactoalbumin
2 Egg Ovalbumin, conalbumin,
lypoprotein
3 Peanut Arachin, lectin-reactive
glycoprotein, peanut I, conarachi
4 Soybean Glycinin
5 Fish oil Allergen M
6 Green beans Albumin
7 Rice Globulin or glutelin
8 tomato Glycoprotein
Literature review

Predisposing factors

allergy
Food
Dietary
habits processi
ng
Physical Psychologic
factor al factor
Literature review

Phatogenesis of food allergy

Physicoche
mical
Gastrointes
tinal
mucosal
barrier

Celluler
Literature review

Phatogenesis of food allergy

IgE mediated allergy

1. Sensitization phase
Antigen catched by B-limphocyte
progenitor antibody-producing
cellsbreak the antigen peptide
fragments that bound selectively to the
major histocompatibility complex (MHC)
class II recognized by the T cell receptor
on CD4 + T helper cells.
Literature review

Phatogenesis of food allergy

IgE mediated allergy:

2. Elitization phase
On subsequent exposure to the agent who
has been sensitized, cells that binds to IgE
bound to each other by agentmast cell
produced inflammatory
mediatorphysiologic changesfast
allergic reactionskin,respiratory,
gastrointestinal symptom.
Food allergy
manifestation

Gastro-
intestina Nausea,vommiting,diarrhea
l and abdominal pain

Urtikaria, pruritus,skin
Skin rash,edema

Respir
Sneezing, rhinorhea,shortness
a of breath
tory
Food allergy
manifestation

Anaphylactic
shock
Difficu
lt to Hypote
Loss of
conscio
Deat
breat nsi
h
usness h
 In vitro
IgE examination examina
Basofl histamine release assay/BHR) tion
Intestinal mast cell histamine release (IMCHR)
In vivo
Skin prick test examin
Intradermal test ation
Patch test
Food challenge test
Family history histo
Feeding history ry
Signs and symptoms of food allergy in infancy to
the present conditions
diagnostic
Food allergy
 Food allergy
Fooddiagnostic
provocation
test single blind
Open food placebo-
challenge controlled food
challenge

double blind
placebo-
controlled food
challenge
 Food allergy
diagnostic
Open Open
food The doctor or food
challen the patient challen The skin test
ge realizes that ge negative for
the patients
the suspected
consume food
food
that is A child with a
suspected history of egg
allergy are
content of the given a cooked
tested foods egg, increased
are not the dose every
disguised. 30 minutes until
all the eggs are
presented
eaten
 hallenge
Food allergy
diagnostic Single
Single
blind
blind
placebo-
placebo-
food
controlled Doctor realized controlled
food what was eaten a child with a
food
challenge by the patient history of egg
challenge
but the patient allergy is
didnt given the egg
that have
The suspected been hidden
food is in other foods.
disguised so
the patient
didnt know
the content of
the food they
consumed
 hallenge
Food allergy
diagnostic Double
Double
blind blind
placebo placebo
controlled controlled
food Doctor and food
Gold
challenge patient do not challenge standard
know what the
patient ate The most
reliable
method
because it
The suspected eliminates
food was bias in
disguised in doctor and
other food patient
Food provocation
test Can not be
Can not be
done in patient Elimination
with a history of diet at least in
apparent 2 weeks
allergic reaction

Patient should
Antihistamin
be free of
stopped at least
symptoms and
5 days in
fasting in the
advance
day of testing

Intensive
medical
supervision
Food provocation
test
The suspected Test with the
food is disguised other food can
in other food or be done on the
capsules diferent days

Total dose : 8-10

Divided into 7
gram dry food,
doses :
100 ml wet food,
1%,4%,10%,15%,2
two fold for meat
0%,25% and 25%
or fish

Increased every
10-30 minutes and
wait for its
reaction 30
minutes after the
last dose is given
Literature
Managemen
review
t of food
allergy

Food
Eliminati
avoidan on diet
ce

Auto
Wear
injector
medical
device
alert
containing
bracelet or
ephinefrin
necklace
e
Literature
Managemen
review
t of food
allergy
Meal plan or diet to eliminate
foods must be done carefully.

Any elimination diet should take into

account the individual's ability to
tolerate the offending food and the
need to avoid nutritional deficiencies.

Nutritionists assistance in
planning the diet and provide
alternative food or groceries.
Literature
Managemen
review
t of food
allergy

For successful elimination diet

notice food labels.
After conducting strict allergen-free
diet for 1-2 years one-third of
children and adult patients no
longer sensitive to food allergens
previously.
Literature
Managemen
review
t of food
allergy

Medical alert Auto-injector epinephrine

bracelet and how to use it
Literature
Managemen
review
t of food
Immunotherapy
allergy
For an individual against an
allergen desensitization pollen and
other environmental allergens.
It is not recommended to treat food
allergies dangerous because of
potential serious anaphylactic
reactions

The only way to prevent an allergic

reaction is to avoid the offending
food.

Gene therapy for peanut allergy is

now being done.
 0.61% of adults are allergic Woods
to peanuts et al
0.09% of adults are allergic
to egg
Prevalence of food allergy 5-11% Indonesi
Allergy Immunology Clinic Cipto a
Mangunkusumo contained 4.6% of food
allergies during 1987-1996
Woman > Men Lovic Lovic
Eating habits infuenced k
bodys reaction
DISCUSSION
DISCUSSION

Likura et
Davis et al: Yoon et al: al:
USA0.6% 3.7% adults JapanEgg is
adults the cause of
allergic to most food
allergic to corn allergies in
peanuts children amount
Wilm et al: to 52.3%.
Allergy Sampson:
Australia Imonology
90% of food
allergic RSCM(2001):
allergies are
chocolate as 10.3% children caused by an
much as allergy to allergy milk,
2%&0.1-0.28% wheat& 8.8% eggs, peanuts,
children have allergic to egg soybeans and
allergy to yolks wheat
soybeans
DISCUSSION

In a prospective study of
480 newborns who were
followed for 3 years
Sampson: 28% reported
experiencing adverse
Adults85% reactions food was
caused by mostly occurs in the first
fish, peanuts year of life.
and shell A quarter of the reported
reaction can be
confirmed by oral food
challenge.
As many as a third of cases
of anaphylactic shock
caused by food allergies.
An estimated 100 fatal
cases were caused by food
allergies occur each year in
the United States.
DISCUSSION

Bock et al.
Careful history-taking including the use of food
diaries by an experienced allergist can often
identify suspect foods.
Elimination diets followed by challenges can
sometimes confirm the existence of a food-
associated adverse reaction.

The gold standard for documenting existence

of a food allergy is double-blind placebo-
controlled food challenge (DBPCFC)
DISCUSSION

Lemke and Taylor :

Prevalence IgE mediated food allergies likely
efect between 2 and 2.5% of the total
population

Bousquet et al and FAO :

Eight food or food groups are thought to account for
more than 90% of all IgE mediated food allergies in the
worldwide basis.
These foods are milk, eggs, fish (all spesies of finfish),
crustacea (shrimp, crab, lobster, crayfish), peanuts,
soybean, treenuts (walnut, hazelnut, pecans, cashew).
DISCUSSION

Zeiger and Heller :

The prevention of development of IgE
mediated food allergies among high-risk infant
has been along sought goal.
The result of several large clinical trial of high-
risk infant followed for several years suggest
that the development of IgE mediated food
allergies can be delayed but not prevented

The maternal diet during pregnancy does not

seem to be a factor because sensitization does
not occur in utero.
 o
DISCUSSION
Hattevig et al, Zeiger and
Heller :
The avoidance of commonly allergenics food in
the infant diet during the first few years of life
often delays the development of food allergies,
but food allergies still may develop after solid
food are introduced.
Kjellman and Bjorksten, Zeiger and
Heller :
Avoidance can be accomplished through breast-
feeding for infants born to parents with histories
of IgE mediated allergies.
 o
DISCUSSION

Sampson :
In a prospective study of 480 newborns who were followed
for 3 years as much as 28% reported experiencing adverse
food reactions was mostly occurs in the first year of life. A
quarter of the reported reaction can be confirmed by oral
food challenges.
As many as a third of cases of anaphylactic shock
caused by food allergies.
An estimated 100 fatal cases were caused by
food allergies occur each year in the United
States
CONCLUSIO
N allergy collection of symptoms that
Food
affect many organs and body systems caused by
food allergies are IgE-mediated reactions, cell-
mediated or both.

The etiology glycoprotein with a molecular

weight of 10 to 70 kilodalton and resistant to
heat , acids and proteolytic enzym.

Imaturitas or disorders of the gastrointestinal

barrier will lead the food allergens enter the
intestinal mucosa and activates the
immunological system response.
CONCLUSIO
N
The clinical symptoms of food allergy
reactionusually affecting the skin,
respiratory system and the gastrointestinal
tract.
Food allergy diagnosis on history, family
history, history of feeding, signs and symptoms
of food allergy in infancy until adolesence.
In vivo examination skin test and food
provocation test.
CONCLUSIO
N
In vitro examination examination of IgE,
monoclonal antibodies, histamine release by
basophils and mast cells release histamine by
intestinal.

Food provocation the gold standard for the

diagnosis of food allergy.

Proved efficient management is to avoid the

offending food
Thank you