GIS-K27 Food Allergyocw.usu.ac.id/.../gis_20102011_slide_food_allergy.pdf · Title: Microsoft...
Transcript of GIS-K27 Food Allergyocw.usu.ac.id/.../gis_20102011_slide_food_allergy.pdf · Title: Microsoft...
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FOOD ALLERGY
Atan Baas Sinuhaji
Department of ChildHealth
School of Medicine,University Of Sumatera Utara
Medan
Adverse food Reaction Adverse food Reaction ( Food Sensitivity)( Food Sensitivity)
ImmunologicImmunologic Non ImmunologicNon Immunologic(Allergy, hypersensitivity) ( Intolerance)(Allergy, hypersensitivity) ( Intolerance)
Ig E Mediated Non Ig E MediatedIg E Mediated Non Ig E Mediated(immediated) ( Late ) (immediated) ( Late )
Early LateEarly Late(0(0--2 h) (22 h) (2--48 h)48 h)
Anaphylaxis EczemaAnaphylaxis Eczema
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Food Intolerance
Host Factor Food Factor
-Enzyme defisiency - infectious m.o
-GI disorder - toxin
-Idiosyncratic - pharmacologic
-Psychologic - contaminant
(food aversion)
HYPERSENSITIVITYHYPERSENSITIVITY
I. I. Ig E, mastcell dependent reactionIg E, mastcell dependent reaction
II. II. Antibody dependent cytotoxic responseAntibody dependent cytotoxic response
III. III. AgAg--Ab complexAb complex
IV. IV. Cell mediatedCell mediated
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CONDITIONS OF ANTIGENECITYCONDITIONS OF ANTIGENECITY
1.1. Foreigness Foreigness �������� “ non self”“ non self”
2.2. Molecular size Molecular size �������� 10.00010.000
-- retained longer in the hostretained longer in the host
3. 3. Internal molecular complexity Internal molecular complexity �������� epitopeepitope
4. 4. SolubilitySolubility
5.5. Others : forms, dose, routes, ajuvants, Others : forms, dose, routes, ajuvants, genetic of the hostgenetic of the host
AntigenAntigen
Immune responseImmune response
ProtectionProtection InjuryInjury
ImmunogenImmunogen AllergenAllergen
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HypersensitivityHypersensitivity
Immune deviation Immune deviation
( Genetic predisposition)( Genetic predisposition)
Ig GIg G Th 1 Th 1 Th 2Th 2 Ig E Ig E
Defense of GI TractDefense of GI Tract
�� Non immunologicNon immunologic
�� ImmunologicImmunologic
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Defense of GI TractDefense of GI Tract
Non immunologicNon immunologic
�� IntraluminalIntraluminal
�� Gastric acidityGastric acidity
�� Gastric enzymesGastric enzymes
�� Pancreatic enzymesPancreatic enzymes
�� PeristalsisPeristalsis
�� Probiotic floraProbiotic flora
�� MucosalMucosal
�� MucinMucin
�� EnterocyteEnterocyte
Defense of GI TractDefense of GI Tract
ImmunologicImmunologic
�� Intraepithelial TIntraepithelial T--cells (CD8)cells (CD8)
�� Lamina propria TLamina propria T--cells (CD4)cells (CD4)
�� BB--cellscells
�� GALTGALT
�� Secr. IgASecr. IgA
�� Non IgA immunoglobulinesNon IgA immunoglobulines
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GALTGALTGALTGALT
(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)(GUT ASSOCIATED LYMPHOID TISSUE)
SCATTERED AGGREGATES
PEYER’S PATCHES
Food allergyFood allergy
Exposure allergenExposure allergen
Genetic predispositionGenetic predisposition
Immature Defense of GI TractImmature Defense of GI Tract
�� DevelopmentDevelopment
�� LeakyLeaky
�� InfectionInfection
�� Immunologic reactionsImmunologic reactions
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MACROMOLECULAR
ANTIGENIC
RESIDENT
BACTERIA
FOOD
VIRUS
ABSORPTION
IMMUNOLOGICALLY MEDIATED
GASTROINTESTINAL DISEASE
-CMPSE
-CELIAC DISEASE
-FOOD ALLERGY
MUCOSAL INJURY
TRANSCELLULERTRANSCELLULER
Tight
Junction
Basolateral
Membrane
Intercelluler
space
E
n
t
e
r
o
c
y
t
e
Luminal
Membrane
Basal
MembraneLamina
propia
PARACELLULERPARACELLULER
Vessel
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Symptomatology in food Symptomatology in food allergyallergy
�� DermatologicalDermatological :: eczema, urticaria, edema, eczema, urticaria, edema, conjunctivitisconjunctivitis
�� GastrointestinalGastrointestinal :: diarrhea, vomiting, colicsdiarrhea, vomiting, colics
�� RespiratoryRespiratory :: closeness, dyspnoea,closeness, dyspnoea,wheeze, cough, rhinitiswheeze, cough, rhinitis
�� NeurologicalNeurological : : migrainemigraine
�� GeneralGeneral : : growth failure, irritable,growth failure, irritable,refusal foodrefusal food
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DIAGNOSING FOOD HYPERSENSITIVITYDIAGNOSING FOOD HYPERSENSITIVITY
1. 1. HistoryHistory
2. 2. Double blind placebo controlled food Double blind placebo controlled food challenge challenge �������� GOLD STANDARDGOLD STANDARD
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HISTORY HISTORY
1. The food suspected of provoking the reaction 1. The food suspected of provoking the reaction and the quantity ingestedand the quantity ingested
2. The time interval between ingestion and the 2. The time interval between ingestion and the development of symptomdevelopment of symptom
3. The type of symptoms elicited by the ingestion3. The type of symptoms elicited by the ingestion
4. Whether ingesting the suspected food 4. Whether ingesting the suspected food produced similar symptoms on other occasionproduced similar symptoms on other occasion
5. Whether other inciting factors,such us 5. Whether other inciting factors,such us exercise,are necessaryexercise,are necessary
6. The time interval from the last reaction to the 6. The time interval from the last reaction to the foodfood
DBPCFCDBPCFC
-- Totally eliminated for 10Totally eliminated for 10--14 days14 days
-- Avoidence of medication for 12Avoidence of medication for 12--96 hours96 hours
If there is a clear history of severe If there is a clear history of severe anaphylaxis following an isolated ingestion of anaphylaxis following an isolated ingestion of a specific food and there is a positive skin a specific food and there is a positive skin test, this patient should not be challengedtest, this patient should not be challenged
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Breast milkBreast milk
Protective against allergy??Protective against allergy??
�� HypoallergenicHypoallergenic
�� Immunological factors (Immunological factors (SSIgA)IgA)
�� Infection reductionInfection reduction
�� Promotes Probiotic FloraPromotes Probiotic Flora
Solid foods introductionSolid foods introduction
avoidance solid foods till 4avoidance solid foods till 4--6 mth6 mth
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BIOTICBIOTICBIOTICBIOTIC
ANTI PRO PRE SYN (EU)
- * FOS
-* GOS ���� Breast milk
•LACTOBACILLUS
•BIFIDOBACTERIUM
DYS
IMBALANCE
* FOS : Fructooligosaccaride
GOS : Galactooligosaccaride
GUT
M.O
NON PATHOGEN PATHOGEN
ECOSYSTEM
HEALTHY
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DYSBIOTIC
IMBALANCE
M.O PATHOGEN M.O NON PATHOGEN
DISEASES
PROBIOTICPROBIOTIC
LIVE MICROORGANISMSLIVE MICROORGANISMS
SUPPLEMENTAL FOODSUPPLEMENTAL FOOD
BENEFICIALLY AFFECT THE HOSTBENEFICIALLY AFFECT THE HOST
MICROBIAL BALANCEMICROBIAL BALANCE