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 TH1 cell migrate to site
Recognition of antigens bound to tissue cells
Activation of TH1 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

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
babys immature gut into the blood
stream
Contain macrophage and other
immune system which may help the
infants immune system to mature
more rapidly

Finish