FOOD INTOLERANCE

WIKIPEDIA- 2013 & Nelson 2004

• Food intolerance:
• Host factors
• Enzyme deficiencie-lactase (primary or
secondary), fructase (maturation delay)
• Gastrointestinal disorders-inflamatory bowel
disease, irritable bowl syndrome
• Idiosyncratic reactions-coffeine in soft drins
(“hyperactivity”)
• Psychologic-food phobias
• Migraine-(rare)
 FOOD INTOLERANCE
• Food Factors
• Infectious organisms-Escherichia coli,
Staphylococcus aureus, clostridium
• Toxins-histamine(scombroid poisoning), saxitoxin
(shellfish)
• Pharmacologic agents-caffein,theobromine
(chocolate, tea), tryptamine (tomatoes), tyramine
(cheese)
• Contminants-heavy metals, pesticides, antibiotics
 FOOD INTOLERANCE
• Food Allergy
• IgE mediated
• Cutaneus-urticaria, angioedema, morbilliform
rashes and fluishing
• Gastrointestinal-oral allergy syndrome,
agtrointestinal anaphylaxis
• Respiratory-acute rhinoconjungtivitis,
bronchospasm (wheezing)
• Generalized-anaphylctic shock
• Mix IgE and Cell Mediated
• Cutaneus-atopic dermatitis
• Gastrointestinal-allergic eosinophilic
esopahgitis and gastroenteritis
• Respiratory-asthma
• Cell mediated
• Cutaneus-contac dermatitis, dermatitis
herpetiformis
• Gastrointestinal-food protein-induced
enterocolitis, proctocolitis, and enteropathy
syndromes, celliac disease
• Respiratory-food induced pulmonary
hemosiderosis (Heiner syndrome)
• Unclassified
• Cow,s milk-induce anemia
 FOOD INTOLERANCE
(Wikipedia)

• Definitions
• Non-allergic food hypersensitivity
• -is the medical name for food intolerance,
loosely referred to as food hypersensitivity,
• -or previously as pseudo-allergic reactions.
• Non-allergic food hypersensitivity should not
be confused with true food allergies.
 FOOD INTOLERANCE
• Food intolerance reactions can include
• pharmacologies,
• metabolic, and
• gastro-intestinal responses to foods
• or food compounds.
• Food intolerance does not include either
psychological responses or foodborne illness
 FOOD INTOLERANCE
• A non-allergic food hypersensitivity :
• is an abnormal physiological response.
• It can be difficult to determine the poorly
tolerated substance as reactions:
• can be delayed,
• dose-dependent, and a
• particular reaction-causing compound
• may be found in many foods.
 FOOD INTOLERANCE
• Signs and symptoms
• Non-IgE-mediated food hypersensitivity (food
intolerance):is more chronic, less acute, less
obvious in its presentation, and often more
difficult to diagnose than a food allergy.[9]
• Symptoms of food intolerance vary greatly,
and can be mistaken for the symptoms of a
food allergy.
 FOOD INTOLERANCE
• Signs and symptoms
• While true allergies are associated with fast-
acting immunoglobulin IgE responses,
• it can be difficult to determine the offending
food causing a food intolerance because the
response generally takes
 FOOD INTOLERANCE
• Food intolerance can present with symptoms
affecting: the skin, respiratpry tract,
gastrointestinal tract (GIT)
• either individually or in combination.
• On the skin may include
• skin rashes, urticaria (hives), angioedema,
dermatitis, and eczema.
 FOOD INTOLERANCE
• Respiratory tract symptoms can include nasal
congestion, sinusitis, pharyngeal irritations,
asthma and an unproductive cough.
• GIT symptoms include mouth ulcers,
abdominal cramp, nausea, gas, intermittent
diarrhea, constipation, irritable bowel
syndrome and may include anaphylaxis
 FOOD INTOLERANCE
• Causes
• Reactions to chemical components of the diet
are more common than true food allergies.
• They are caused by various organic chemicals
occurring naturally in a wide variety of foods,
both of animal and vegetable origin more
often than to food additives, preservatives,
colourings and flavourings, such as sulfies or
dyes.
 FOOD INTOLERANCE
• Both natural and artificial ingredients may
cause adverse reactions in sensitive people if
consumed in sufficient amount, the degree of
sensitivity varying between individuals.
 FOOD INTOLERANCE
• Pharmacological responses to naturally
occurring
• compounds in food, or
• chemical intolerance,
• can occur in individuals from both allergic and
non-allergic family backgrounds.
• Symptoms may begin at any age, and may
develop quickly or slowly.
 FOOD INTOLERANCE
• Triggers may range from a viral infection or
illness to environmental chemical exposure.
• It occurs more commonly in women, which
may be because of hormone differences, as
many food chemicals mimic hormones.
 FOOD INTOLERANCE
• A deficiency in digestive enzymes can also cause
some types of food intolerances. Lactose
intolerance is a result of the body not producing
sufficient lactase to digest the lactose in milk;
• dairy foods which are lower in lactose, such as
cheese, are less likely to trigger a reaction in this
case.
• Another carbohydrate intolerance caused by
enzyme deficiency is hereditary fructose
intolerance.
 FOOD INTOLERANCE
• Celiac disease an autoimmune disorder
caused by an immune response to the protein
gluten, results in gluten intolerance and can
lead to temporary lactose intolerance.
• The most widely distributed naturally
occurring food chemical capable of provoking
reactions is salicylate although tartrazine and
benzoic acid are well recognised in susceptible
individuals.
 FOOD INTOLERANCE
• Benzoates and salicylates occur naturally in
many different foods, including fruits, juices,
vegetables, spices, herbs, nuts, tea, wines, and
coffee. Salicylate sensitivity causes reactions
to not only aspirin and NSAIDs but also foods
in which salicylates naturally occur, such as
cherries.
 FOOD INTOLERANCE
• Other natural chemicals which commonly
cause reactions and cross reactivity include
amines, nitrates, sulphites and some
antioxidants. Chemicals involved in aroma and
flavour are often suspect.
 FOOD INTOLERANCE
• Pathogenesis
• This section requires expansion. (January 2009)
• The term food allergy is widely misused for all
adverse reactions to food. Food allergy (FA) is a
food hypersensitivity occurring in susceptible
individuals, which is mediated by a classical
immune mechanism specific for the food itself.
• The best established mechanism in FA is due to
the presence of IgE antibodies against the
offending food.
 FOOD INTOLERANCE
• Food intolerance (FI) are all other adverse
reactions to food.
• Subgroups of FI are enzymatic (e.g. lactose
intolerance due to lactase deficiency),
pharmacological (e.g. reactions against
biogenic amines, histamine intolerance), and
undefined food intolerance (e.g. against some
food additives).
 FOOD INTOLERANCE
• As knowledge of mechanisms and causes of
food intolerance improve, nomenclature will
be updated. There is no worldwide scientific
consensus on the pathogenesis of food
intolerance.
• Food intolerances can be caused by enzymatic
defects in the digestive system, can also result
from pharmacological effects of vasoactive
amines present in foods (e.g. Histamine),
among other metabolic, pharmacological and
digestive abnormalities.
• A frequent misconception among the general public is confusion between
cow's milk allergy (CMA) and cow’s milk intolerance, which is usually
intolerance to lactose. There are at least two, and possibly more, distinct
pathologies. Hypersensitivity to milk is often broadly classified into
immunoglobulin E (IgE)-mediated allergy and non-IgE-mediated
intolerance. Food antigens contact the immune system throughout the
intestinal tract via the gut associated lymphoid tissue (GALT), where
interactions between antigen presenting cells and T cells direct the type of
immune response mounted. Unresponsiveness of the immune system to
dietary antigens is termed "oral tolerance" and is believed to involve the
deletion or switching off of reactive antigen-specific T cells and the
production of regulatory T cells (T reg) that quell inflammatory responses
to benign antigens. In the case of IgE-mediated allergies, a deficiency in
regulation and a polarisation of specific effector T cells towards type-2 T
helper cells (Th2) lead to signalling of B-cells to produce milk protein-
specific IgE. Whereas non-IgE-mediated reactions (intolerances) may be
due to Th1 mediated inflammation. Dysfunctional T reg cell activity has
been identified as a factor in both allergy/ intolerance mechanisms.[43]
• The immunopathological mechanisms of non-IgE-mediated
intolerance in particular remain poorly understood, and
this has hindered the development of simple and reliable
diagnostics. Adults with non-IgE-mediated intolerance to
milk tend to suffer ongoing reactions without the
development of tolerance. The precise immunopathological
mechanisms of non-IgE-mediated intolerance remain
unclear. A number of mechanisms have been implicated,
including type-1 T helper cell (Th1) mediated reactions, the
formation of immune complexes leading to the activation
of Complement, or T-cell/mast cell/neuron interactions
inducing functional changes in smooth muscle action and
intestinal motility.
 Definisi
• Non-allergic food hypersensitiviy
• Widely for varied physiological responses
• Associated with a particular food or
compound found in the range of foods
• Include pharmacologic, metabolic & gastro-
intestinal responses to foods or foods
compounds, does not include either
psychological rsponses or foodborne illnes
 Sign & symptoms
• Food intolerance has been found associated
with:
• Irritable bowel syndrome & inflamatory bowel
diease
• Chronic constipation, chronic hepaitis C
infection, eczema, NSAID intolerance,
respiratory complains including asthma,
rhinitis and headache, functional dyspepsia,
eosinophylic esophagitis and ENT illnesses