Nutrition and Food Allergy

Definitions ‰ Antigenicity: ability of a substance to combine

specifically with a preformed antibody from a previously sensitized organism ‰ Allergenicity: abnormal immune reaction

resulting in adverse clinical symptoms

PHYSIOLOGY

c

a Epitelial cell

b

M cell

Peyer’s patch Portal vein Mesenteric lymph node

Lamina propria

a. Via dendritic cell

Antigen

c

a Cél. epitelial

Lamina propria

Denditirc cell

b Lymphatic

Célula M

Placa de Peyer

c

a b. Via M cell Antigen

b

Célula M Dendritic cell

Epitelial cell Follicle Germinal center Placa de Peyer

T cell

T cell IgA Serosa

Lamina propria

c. Via epitelial cell Epitelial cell

c

a Antigen

Lamina propria T cell Macrophage Capillary

b

Célula M Lymphatic

Respuesta inmune intestinal hacia antígenos alimentarios ANTIGENO SOLUBLE

ANTIGENO

ANTIGENO PARTICULADO

3

1

Célula epitelial intestinal

Daño mucosa

Célula M

d

9

C

LTc CD8+

D

LT TGF-BETA IL-10

IgA

8

B

IL-10 Th3

CPA

5 IL-4

C Alergia

Th0

IL-12

7 Th2

Tolerancia oral

2

IL-4

Th1

4

IFN-γ

IgE

E

6

B

RESPUESTA CELULAR

PHYSIOPATHOLOGY

Influence of Dietary Protein on Immune Response DIETARY PROTEIN PROTEIN SOURCE • QUALITY • QUANTITY

DIETARY TREATMENT • DIFFERENT PROTEIN • HYDROLYZED PROTEIN LONG CHAIN POLYUNSATURATED FATTY ACIDS

AGE ??

?

GUT FACTORS • PROCESSING • PERMEABILITY

?

? ?

INFECTION ?

IMMUNE RESPONSE

TOLERANCE GENETICS

ALLERGIC MANIFESTATIONS RAPID REACTION SLOW REACTION Ig E MEDIATED RESPONSE (Permanent: Fish, Peanut)

AGE

ENTERIC RESPONSE (Transient: Cow Milk, Soy)

Food allergy IgE mediated: ‰ urticaria ‰ angioedema ‰ morbilliform rashes ‰ acute rhinoconjunctivitis ‰ acute asthma ‰ Anaphylaxis ‰ food-associated exerciseinduced anaphylaxis

IgE associated: ‰ contact dermatitis ‰ dermatitis herpetiformis ‰ celiac disease ‰ Heiner syndrome

Classification of GI hypersensitivities to food

IgE

IgE and/or cell

Pollen-food allergy syndrome (oral allergy syndrome) GI anaphylaxis

eosinophilic esophagitis gastroenteritis

Non-IgE proctitis enterocolitis celiac dz

Sampson HA. J Allergy Clin Immunol. 2003;111:S540-S547

Allergy Not Mixed IgE-mediated/non–IgE-mediated: ‰ Atopic dermatitis ‰ Asthma

Predicting Milk Protein Sensitivity

Up to 72 %

Both parents with same atopic symptoms

43 %

Both parents atopic

32 %

One sibling atopic

20 %

12 %

One parent atopic

No parent atopic

From Kjellman NIM Acta Paediatr Scand. 1977;66:465-471.

Gastrointestinal Manifestations of Milk Allergy Esophagitis Acute Diarrhea Post-enteritis Syndrome Malabsorption Colic Colitis Vomiting- Delayed Gastric Emptying Abdominal Distention Intestinal Bleeding Protein-losing Enteropthy Constipation

Allergic colitis ‰ ‰ ‰

‰

Most common cause of colitis in the infant Onset within first few mo. of life (Mean 66 d,