Nutrition and

The Immune Function

Agussalim Bukhari
Department of Nutrition
Faculty of Medicine Hasanuddin University

1
Topics
 Malnutrition & Immune
function
 Effect of nutrients on immune
system
 Food allergy
 Food intolerance 2
Correlation between Nutritional status and
Immune Function

Suppressed immune,
Susceptible to infection Immune activation
Normal immune function Susceptible to inflammatory
disease
Undernutrition
Optimum nutrition
Overnutrition

3
SEVERE PROTEIN ENERGY MALNUTRITION (PEM)

MARASMUS

KWASHIORKOR
4
 MARASMIC-KWASHIORKOR 5
KWASHIRKOR
 60

50
Lymphocytes (%)

40

30 well-nourished
malnourished
20

10

0
CD4+ CD8+

The proportion of T Lymphocyte subsets in children with PEM and

well-nourished controls. The CD4/CD8 ratio is decreased
6
Hospital malnutrition
 Malnutrition characterized by
hypoalbuminemia is associated
with increased morbidity,
mortality and prolonged hospital
length of stay

7
8
Types of Malnutrition

• Marasmus
• Kwashiorkor
• Mixed

Because this is a disease with multiple etiologies, the

best terminology would probably be polydeficient
malnutrition.

Green CJ. Clin Nutr 1999;18(s):3-28

How common is Malnutrition in
surgical patients?
25% of surgical patients are malnourished on admission!

Does80it matter?
70
60 Well
50 nourished
Moderately
40
malnourished
30 Severly
20 malnourished
10
0
P<0.005 (infections)
Infections (%) LOS (days) P<0.0001 (LOS)

McWirther, BMJ 1994;308:945-8. Baker, N Engl J Med 1982;306:969-72

Malnutrition Among Hospitalized
Patients:
A Problem of Physician
Awareness
 Up to 50% of hospitalized patients may be
malnourished on admission
 Before nutritional assessment training:
– Only 12.5% of malnourished patients are
identified
 After 4 hours of training:
– 100% of patients are identified

Roubenoff et al. Arch Intern Med 1987

 Prevalence of Malnutrition
in Hospitalized Patients
202 Patients 10%
GI Tract Surgery Severely Malnourished

21%
Moderately
Malnourished
69%
Adequate
Nutritional
State

Detsky et al. JPEN 1987

Frequency of malnutrition (’90s)

Country Patient groups Frequency of

malnutrition (%)

USA (H Willcutts) General surgery 65

USA (BR Bistrian) General surgery 50
USA (RL Weinsier) Internal medicine 48
USA (BS Linn) Internal medicine 32-45
UK (MD Bastow) Orthopedic surgery 19
England (GL Hill) General surgery 25-40
USA (MD Willard) General medicine/surgery 31
England (GL Hill) Inflammatory bowel disease 30-50
14
 Prevalence of Malnutrition –
(Indonesia)
Bagian Penyakit Dalam RSHS (2006):
Malnutrisi 71.1% dan 28,9% diantaranya
adalah Malnutrisi Berat

Bagaimana prevalensi malnutrisi di RS saudara?

Malnutrition and its
Consequences
 Changes in intestinal barrier
 Reduction in glomerular filtration
 Alterations in cardiac function
 Altered drug pharmacokinetics

Roediger 1994; Green 1999; Zarowitz 1990

Malnutrition and its
Consequences
 Loss of weight
 Slow wound healing
 Impaired immunity
 Increase in length of hospital stays
 Increased treatment costs
 Increase in mortality
OBESITY AND IMMUNE FUNCTION

18
Obesity and Insulin Resistance

MCP-1, TNFa, IL-6

Insulin Resistance 19
Effects of Nutrients on immune
function

 Nutrients are primary factors in the

regulation of the human immune
response
 Both Macronutrients and micronutrients
affect immune-system function through
actions at several levels in GI tract,
thymus, spleen, regional lymph nodes
and immune cells of the circulating blood
20
Effects of nutrition on immune
responses

• Protein-Calorie Malnutrition
• Calorie intake
• Protein and amino acids
• Nucleic acids
• lipids
• Elements/Minerals
• Vitamins
• Antioxidants 21
Effect of protein
and amino acid on
immune function

22
Protein

 Inadequate protein intake----

suboptimal tissue repair and
decreased resistance to
infections and tumors

23
Arginine

• Arginine: a semi-essential amino

acid
• Arginine is important for cell-
mediated immunity and exogenous
sources are often required during
sepsis
• Important for the growth and function
of T lymphocyte
24
Arginine cont’d
• Increases the cytotoxic activities of
macrophages, NK cells, cytotoxic T
cells and neutrophils by releasing
GH
• Nitric oxide (NO), a metabolite of
arginine has effects as tumoricidal ,
microbicidal, and vasodilator

25
 Glutamine
• Energy source for lymphocytes and
macrophages
• molecular intermediates for purine and
pyrimidine synthesis
• Important for the integrity of intestinal
immune system
• Prevents intestinal mucosal atrophy
and leukocyte depletion
26
 Glutamine cont’d
• Reduces bacterial translocation
across the gut epithelium
• Increases secretory IgA
production
• Glutamine and arginine enhance
wound healing, resistance to
infection, improve immune
function 27
 Nucleic Acids
• Preformed purine & pyrimidine in the
diet---maintain immune function
• Dietary restriction of nucleotides ----slow
maturation of T lymphocytes
• Nucleotide-free diets ---- impair DTH
response, IL-2, IFN-γ productions, T-cell
proliferation, NK cell cytotoxicity, PMN
function
• critically ill patients fed with diets
containing nucleotide have shorter
hospitalization
28
Effect of mineral on
immune function

29
Copper/Cu
Cu deficiency -----susceptible to infection
Cu deficiency ---Impairs phagocyte function,
decreases T-lymphocyte numbers and
activities, lower IL-2 production, and
increases B Cell numbers
Excess dietary Cu also results in reduction in
phagocyte numbers and performance
Cu involved in complement function, cell
membrane integrity, Ig Structure, Cu-Zn SOD,
interaction with Fe

30
Iron (Fe)
Fe deficiency---impaired DTH reaction,
impaired neutrophil and macrophage
cytotoxic activity, reduction in :
lymphocyte proliferation, T cell numbers,
cytokine release, antibody proliferation, &
lymphoid tissue atrophy
Fe involved in mitochondrial energy
production, a component of many
metalloenzymes including NO synthase,
COX, lipoxygenase and catalase

31
Magnesium (Mg)

 Mg deficiency---increases inflammatory
cells (esp. eosinophils)
 Mg def. ---- increased risk of anaphylactic
shock due to increased levels of tissue
histamine and histamine release by mast
cells
 Mg def. ---elevated cytokines (IL-1, IL-6
and TNF-α)
32
 Selenium (Se)
 Se is a component of Glutathione
peroxidase (GPx), an antioxidant enzyme
 Se Defic.----- susceptible to infection,
decreased antibody synthesis,
cytotoxicity, cytokine secretion, and
lymphocyte proliferation
 Chronic Se Defic.----Cancer
 Se supplement---increases immune
function
33
 Zinc
Zn influences the activity of multiple enzymes
involved in replication and transcription including
thymidine kinase expression, DNA polymerase,
RNA polymerase, and transcription factors such
as NFKB
Zn involved in T lymphocyte activation and
signal transduction
Zn prevents toxin-induced apoptosis (cell-death)
A component of antioxidant superoxide
dismutase (SOD)

34
Zinc (Zn) Deficiency

 Zn Defic.----intrauterine growth
retardation
 Zn Defic.---damages epidermal cells,
linings of the GI and pulmonary tract
 Lymphopenia
 Decreased the function of neutrophil,
monocyte, macrophage, NK cells T- and
B-cells
35
Fat and immune
function

36
Fat and immune function

High fat diets -----diminished innate

immune responses and T-cell
proliferation
Human NK cells activity is increased by
reduced fat intake to < 30% energy
intake
Diets deficient in n-6 or n-3 fatty acid---
decrease innate immune function
37
n-3 PUFA (Fish oil)

 Posses anti-inflammatory properties

 Have been used to treat autoimmune
disorders such as rheumatoid arthritis,
SLE, inflammatory bowel diseases, and
allergic diseases

38
Vitamin and
immune function

39
B Complex vitamins

 Deficiency of B1, B2,

Pantothenic acid (B5), B6, Biotin
(B8), B12, and Folic acid,, are all
associated with impaired cellular
and humoral imune function

40
 Vitamin C
 Vitamin C defic.------decrease in
resistance to infection and cancer,
phagocyte mobility and phagocytosis,
the DTH response, skin allograf
rejection and wound repair
 High doses arrest lymphocyte
proliferation
41
Vitamin A deficiency
 Susceptible to infection
 Decreased integrity of epithel
and mucosal secretion
 Reduced number of leukocytes,
lymphoid organ weight,
complement,
 impaired T-cell function
42
Vitamin D
Vitamin D receptor (VDR) presents
in mononuclear phagocytes,
lymphocytes and affect their
proliferation and immune function
Inhibits Th1 functions and not those
of Th2 or CD8+ T cells
This overall promotion of immuno
suppression may be important in the
reported modulation of autoimmune
diseases 43
 Vitamin E
 Vit E defic.---depressed leukocyte
proliferation, lower chemotaxis and
phagocytosis by PMN and
macrophages, decreased tumor
resistance
 High Vit E intake increases
resistance to infection among the
elderly 44
FOOD ALLERGY

45
WHAT IS FOOD ALLERGY

Is a response of the immune

system to a component of food,
almost invariably a protein
Or
A molecule linked to a protein, that
the immune system recognizes as
a foreign to the body
Or
FOOD HYPERSENSITIVITY
46
 FOOD ALLERGY
 COMMON IN INFANCY (5-8%)
 REPRESENTS A SMALL PROPORTION
OF FOOD REACTION IN THE ADULT
(1.5%)
 SOMETIMES FOOD ALLERGY IS
LIFELONG

47
The most offending foods in allergy 48
Mechanism of Food allergy

 Type I Hypersensitivity ---- IgE

 Type III Hypersensitivity
Non-IgE
 Type IV Hypersensitivity

49
 50
Sensitization process and allergic reaction
51
 Fig 5-8 . Activation of mast cell in type I hypersensitivity and release
of their mediators. ECF, eosinophil chemotactic factor; NCF, neutrophil
Chemotactic factors; PAF, platelet-activating factor.
MAST CELL DEGRANULATION
 Figure 19-5 Biochemical events of mast cell activation. Cross-linking of bound IgE by antigen is thought to activate protein tyrosine kinases (Syk and Lyn), which in turn
cause activation of a MAP kinase cascade and a phosphatidylinositol-specific phospholipase C (PI-PLC&gamma;). PI-PLC&gamma; catalyzes the release of IP3 and
DAG from membrane PIP2. IP3 causes release of intracellular calcium from the endoplasmic reticulum. Calcium and DAG activate PKC, which phosphorylates substrates
such as myosin light chain protein and thereby leads to the degradation and release of preformed mediators. Calcium and MAP kinases combine to activate the enzyme
cytosolic phospholipase A2 (cPLA2), which initiates the synthesis of lipid mediators.

Downloaded from: StudentConsult (on 20 November 2007 07:29 AM)

© 2005 Elsevier
 TYPE III HYPERSENSITIVITY
 INVOLVES IgM AND IgG
 CHEMICALS FORMED IN THE COMPLEMENT
CASCADE
 STEP REACTION ARE:
 T-cell lymphocytes recognize the antigen as
foreign after it is processed by macrophages
 IgM and later IgG are produced in response to the
antigen
 Ag-Ab complexes are formed
 The complement cascade is triggered
 Anaphylatoxins formed in the complement
cascade cause the release of inflammatory
mediators
55
TYPE IV HYPERSENSITIVITY

 T cell lymphocytes and cytokines

 Called as contact allergy
 T-cells lymphocytes respond to the
allergen - release of cytokine.
 An immediate reaction when allergens
come into contact with the lips, tongue,
mouth and GIT.
 Example: Nickel allergy
56
Allergy
as an Inflammatory Process

 Symptoms of allergy result from the release of

inflammatory mediators
 Histamin – increases the permeability of
capillaries – swelling
 Rhinitis – is due to fluid buildup in tissues in
nasal passages
 Excessive fluid in the skin causes urticaria
(hives) and angioedema
 Histamin also causes itching and vasodilation,
resulting in flushing or reddening of the skin

57
 Continue ----

Allergy as an Inflammatory Process

 Prostaglandins caused
vasodilation and vasocontriction

 Leukotrienes - contraction of
smooth muscle – bronhospasm of
asthma

 Bradykinin in conjunction with

prostaglandins causes pain.
58
Symptoms of food Allergy
 Urticaria
 Angioedema
 Wheezing
 Asthma
 Vomiting
 Rhinorrhea
 Itching --- contact dermatitis
 Nausea
 Allergic conjunctivitis
 anaphylaxis
59
60
61
 FACTOR CONTRIBUTING TO THE
EXPRESSION OF ALLERGY TO FOODS

 INHERITED
 PHYSIOLOGICAL CONDITIONS
1. INCREASED PERMEABILITY OF THE INTESTINAL
MUCOSA
- IMMATURITY
- INFLAMMATION IN THE DIGESTIVE TRACT
2. COMBINED ALLERGIC REACTIONS
3. ENCHANCES UPTAKE OF FOOD ALLERGENS
4. EXERCISE
5. CHANGES IN HORMONE LEVEL
6. STRESS
7. FREQUENCY OF EXPOSURE 62
ANAPHYLACTIC REACTIONS
TO FOODS

 Occurrence of Anaphylactic reactions

to foods
 Person with asthmatic -- more likely than
general population
 Increased when the person is receiving
desensitization injections or is allergic to
wasp and bee venom
 Most commonly food are ” peanuts, nuts,
shellfish, fish, cow’s milk, and egg”
 Most study --- 80% of atopic children are
allergic to only one or two foods.
63
 Continues ---

Anaphylactic reaction to cow’s milk,

egg, wheat and chicken in children
under three year of age
Infant and toddlers tend to outgrow
early allergies to certain foods, such
as milk, egg, wheat and soy
Food allergy occurs after 3 yo, the
allergy is less likely to be outgrown.
Allergies to certain other foods – to
be outgrown or may persist for a
person’s lifetime --- such as: peanuts,
nut, shellfish and fish.
64
ALLERGENIC CROSS-REACTIVITY BETWEEN
BOTANICALLY RELATED PLANTS

 CROSS REACTIVITY DEFINED AS A

CONNECTION BETWEEN TWO OR MORE
ALLERGENS, WHEATHER RELATED OR NOT,
THAT CAUSES THEM TO INDUCE SIMILAR
CLINICAL REACTIONS

 NOT VALID THAT PLANTS BELONG TO THE

SAME FAMILY ARE NECESSSARILY RELATED
ANTIGENECALLY

 ALLERGIC REACTION TO A SINGLE SPECIES

DOES NOT AUTOMATICALLY LEAD TO ALL
MEMBERS OT THAT PLANT FAMILY
65
 ALLERGENIC CROSS-REACTIVITY
BETWEEN UNRELATED PLANT SPECIES

 Recent study has demonstrated the

presence of cross reacting antigens in
botanically unrelated, allergenic plant
species.

 The allergens may be inhaled or

consumed as food

66
COMMON ANTIGENS HAVE BEEN
DEMONSTRATED WITHIN EACH OF THE
FOLLOWING GROUPINGS:

 1. BIRCH POLLEN, HAZELNUT, POTATO AND APPLE

 2. APPLE, CARROT AND CELERY
 3. BIRCH POLLEN, NUT, APPLE AND FRUIT WITH STONE
 4. HAZELNUT, RYE GRAIN, SESAME SEEDS, KIWI, AND
POPPY SEED
 5. BIRCH POLLEN, MUGWORT POLLEN, APPLE, CELERY
AND
CARROT
 6. BIRCH POLLEN, APPLE, CELERY, CARROT, POTATO,
HAZELNUT, ORANGE, TOMATO AND PEANUT
 7. REGWEED POLLEN AND WATERMELON
 8. REGWEED POLLEN, MELON AND BANANA
 9. LATEX, BANANA, AVOCADO, KIWI FRUIT, CHESTNUT,
SOYBEAN, PEANUT, PAPAYA, FIG. 67
FOODS MOST LIKELY TO CAUSE A SEVERE
REACTION IN THE HYPERSENSITIVE PERSON

 Peanuts

 Green peas

 Tree nut

 Shellfish

 Finfish

 Egg white

 Cow’s milk protein in infants

68
Tree nuts 69
Green bean Green peas

70
 Food additives derived from
potentially allergenic foods

Name Source Foods likely to contain Function of

the additive foods
Lecithin Egg Boxed breakfast cereal Antioxidant and
Egg yolk Candy emollient
Soy bean Chocolates composed of
Corn Breads, rolls, burns choline,
Margarine phosphoric acid,
fatty acids and
glycerin

Annatto Extract from Dairy products (cheese, Coloring agent

the seed of butter) ( yellow to pink)
tropical tree Breakfast cereal
Baked goods
margarines 71
 MILK ALLERGY
 BIOLOGICAL MECHANISMS
 Results when the immune system produces
antibodies against milk allergen
 The allergenicity test using skin test and oral
challenges
 Casein protein produced the highest # of
positive skin tests in children with milk allergy
 Children or adults react more than one milk
protein
 ANTIBODIES produced against milk proteins may:
IgE, IgM, IgG, sometimes IgA

72
MANAGEMENT OF MILK ALLERGY

 Elimination dietary milk

 Foods containing milk
 Product from milk
 Liquid and evaporated milk
 Fermented milks (yogurt, buttermilk)
 Cream
 All cheeses
 Ice cream
 Ice milk

73
Food substitutes
 Milk provide:
protein, calcium and vitamin D

 Protein substitute
 Readily available from fish, meat or
combinations of legumes, nut, grains
 Adequate dietary protein does not depend on
ingesting milk

 Calcium substitute
 Canned fish such as tuna , sardines, salmon
eaten with the bones
 Green leafy vegetable: broccoli, beet, turnip
 Calcium from vegetable is not as readily
available as from animal sources

74
 TREATMENT
 COMPLETE DIETARY EXCLUSION
OF COW’S MILK

 70 -80% ALLERGIC TO COW’S ARE

ALSO ALLERGIC TO GOAT’S MILK
PROTEINS

 MILK SUBSTITUTE IS USUALLY

NECESSARY
75
 EGG ALLERGY
 Mayor proteins for egg allergy present in egg white
 Ovalbumin
 Conalbumin ( ovotransferrin )
 Ovomucoid
 Yellow egg present as livetins derived from the
blood of the hen

 Cross reactivity may occur between white and

yellow egg
 Ovomucoid is heat stable, persons allergic to this
component react to both cooked and raw egg
 IgE Antibodies are produces to egg proteins, which
differ from the protein in chicken flesh
76
EGG WHITE PROTEINS

 OVALBUMIN

 CONALBUMIN

 OVOMUCOID

 OVOMUCIN

 LYSOZYME
77
EGG YOLK PROTEINS

 LIPOVITELLIN

 PHOSVITIN

 LOW DENSITY LIPOPROTEINS

 LIVERTONS

78
Asthma provoking diet

 Cow’s milk Food Additives

 Egg -Sulfite
 Peanut -Tartrazine
-Benzoate
 Wheat -MSG
 Corn
 Fish

79
Diagnosis of Food Allergy

 Anamnesis
 Physical exam.:Symptoms & signs
 Elimination and challenge test
 Skin test
 Lab: IgE, eosonophil, ELISA, RAST

80
Food Allergy Tests
 Used alone lab tests are of little value in
detecting food allergy and can be
misleading unless the clinical history is
also considered

 With few exceptions (namely eggs, nuts,

fish) skin test and blood test for food
allergy are unreliable or misleading for
the following reasons:
81
Food Allergy test cont’d
- people may have IgE Ab, but no
symptoms
- Food can cause non-specific (“irritant”)
skin reactions
- The reaction may not be mediated by IgE
antibodies
 Only about 1/3 of person with positive

skin test or serum specific IgE show

clinical symptoms during food challenge 82
Skin Tests

 Prick test
 Scratch test
 Intradermal test----more sensitive but
dangerous of an anaphylactic shock

83
Blood test
 Specific IgE or Total IgE (RAST,
radioallergosorbent test)
 Many atopic individuals exhibit an IgE with
normal values
 Normal IgE level does not rule out the
diagnosis of food allergy
 Other antibody implicated in food allergy is
IgG4
 Although IgG4 may be high in patients with
food allergy, it can be found high in individuals
who tolerate these nutrients 84
Reliable test

 Food challenge
Diagnosis
- Elimination & challenge test
- Exposure diary

85
Exposure Diary
Day1 Day2 Day3 Day4 Day5 Day6 Day7

Breakfast
Symptoms
Medication

Lunch
Symptoms
Medication

Dinner
Symptoms
Medication

86
Management

 Avoidance/elimination of allergens
 Pharmacotherapy
 Food substitution

87
Food Intolerance (Adverse
reaction to food)
 Food intolerance is adverse reaction to
food due to a non-immunologic
mechanism such as toxic, pharmacologic,
metabolic, or idiosyncrasy reaction
 Symptoms mimick those of allergy
reaction

88
 LACTOSE INTOLERANCE
 Not involve a response by the immune system
 No antibodies are produced
 Enzyme lactase is insufficient to break down
the quantity of lactose
consumed at any one time
 Symptoms are pain, bloating and gas due to
bacterial fermentation of lactose

89
LACTOSE INTOLERANCE
 Lactase produced by the brush border cells of the small intestine -
--
damaged --- inflammation (infection or allergy) --- or congenital
characteristic, the sugar remain undigested – microbial enzymes
metabolize lactose –variety organic acid (lactic and propionic
acids),
gases (hydrogen)– imbalance result from the exceed sugar and
acid ---
water is drawn to correct the problem---- DIARRHEA

90
 INCIDENCE OF LACTASE
DEFICIENCY
 Asian, Black African races, people from mediterranean
region, lose of the ability to produce lactase
 Starting five year of age
 Prevalence about 80%
 20% of North European origin lose ability to produce
lactase
 Lactase deficiency uncommon in infants---lactose is
principal sugar in human milk and infants require
lactase to digest their mother’s milk.

91
INCIDENCE OF LACTASE
DEFICIENCY

 Secondary lactase deficiency can

develop in infant following a bacterial and
viral infection of digestive tract--- diarrhea
 Infant unable to tolerate lactose until the
infection subsides and the intestinal
mucosa recovers.

92
ADVERSE REACTION
TO FOOD ADDITIVES

 FOOD ADDITIVES;

any substance, including any

source of radiation, the used of
which results, or may reasonably
be expected to result, in it or its by
products becoming a part of or
affecting the characteristics of food

93
PRESERVATIVES AS COLORING AGENT
( to provide taste, odor, and texture )

 Dyes such as tartrazine, erythrosine

 Preservatives such as: sulfites, benzoates, sorbates
 Flavoring agents and flavor enchancers;
monosodium glutamate (MSG)
 Ripening agents; ethylene
 Antioxidants; butylated hydroxyanisole (BHA) ,
butylated hydroxytoluene (BHT), sodium nitrite
 Emulsifiers, lecithin, polysorbate
 Texturizers; calcium chloride,
 Humectants; glycerine, propylene glycol
 Thickeners & stabilizers; gum tragacanth, agar-agar
94
 SOURCE OF FOOD ADDITIVES
 CHEMICAL ADDITIVES --- USED EXTENSIVELY
IN MANUFACTURED FOODS
 PROBLEMS FOR PERSONS WITH FOOD
SENSITIVITIES
 CHEMICALS; DIVERSE IN COMPOSITION AND
TYPES

 DERIVED FROM NATURAL SOURCES

( CHEMICAL PROCESSES) & SYNTHESIZED
FROM INORGANIC SOURCES.
 ??? ---- VERY LITTLE UNDERSTANDING OF
HOW THE CHEMICAL CAUSES THE ADVERSE
CLINICAL EFFECTS
95
CLINICAL REACTIONS
TO FOOD ADDITIVES

 Urticaria
 Angioedema
 Asthma
 Rhinitis
 Headache
 Irritable bowel syndrome

96
 clinical reaction continues -----

 HYPERACTIVITY
FOOD COLORS
PRESERVATIVES
MANY FOODS

 SENSITIVITY TO MONO SODIUM GLUTAMATE

SYMPTOMS RESEMBLE TO MYOCARDIAL
INFARCTION, INCLUDING TIGHTNESS AND
PAIN IN THE CHEST WHICH RADIATES TO THE
ARMS, PALPITATIONS AND FAINTNESS.

97
FOOD ADDITIVES MOST FREQUENTLY IMPLICATED
IN ADVERSE REACTIONS

 TARTRAZINE AND OTHERS FOOD DYES

 SULFITES
 NITRATES AND NITRITES
 BENZOATS
 SORBATES
 BUTYLATED HYDROXYANISOLE (BHA)
 BUTYLATED HYDROXYTOLUENE (BHT)
 SALICYLATES
 MONOSODIUM GLUTAMATE AND OTHER GLUTAMATES

98
REPRESENTATIVE NONIMMUNOLOGIC REACTIONS TO FOOD
CAUSE ASSOCIATED FOODS SYMPTOMS

Gastrointestinal Disorders
Foods containing lactose and milk Bloating,flatulence,diarrhea,abd
Enzyme deficiency
ominal pain
Lactase
Fava or broad beans Hemolityc anemia
Glukosa-6-phosphate-
dehidrogenase
Diseases
Symptoms may be precipitated by Bloating,loose stools, abdominal
Cystic Fibrosis
many foods, especially high fat
Gallbladder disease pain
foods or certain protein
Enteropathies

Inborn errors of metabolism Elevated serum phenylalanine

Food containing phenylalanin
Phenylketonuria levels,mental retardation

Galaktosemia Vomiting,lethargy,failure to
Food containing lactosa and
thrive
galactosa
Wide variety of symptoms
Physiologic reaction involving any system
Symptoms may be precipitated by any
food
Reaction to pharmacologic agents
in foods
Vasoactive amines
Migraine headaches
Phenylethylamine Cocholate, aged cheese, red wine

Tyramine Migraine headaches,cutaneous

Cheddar cheese, French
erythem, urticaria, and
cheese,Brewer’s yeast, Chianti
hypertensive crisis in patients
wine, canned fish
taking monoamine oxidase (MAO)
inhibitors
Erythema,headaches,decreased
Fermented cheese, fermented foods
Histamine (e.g. Sauerkraut, pork sausagees,
blood pressure 99
canned tuna, anchvies, sardines).
REPRESENTATIVE NONIMMUNOLOGIC REACTIONS TO FOOD
CAUSE ASSOCIATED FOODS SYMPTOMS

Histamine-realising agents Shellfish, Chocolate, Urticaria,eczema,pruritus

strawberry, tomatoes, peanuts,
pork, wine, phineapple

Reactions to Food Additives
Tartrazine or FD & C Yellow No.5
Benzoic acid or sodium benzoate
Sulfites
Sodium sulfite , pottasiumsulfite ,
sodium metabisulfite,
metabisulfate , sodium bisulfate , sulfur wine, beer
dioxide
Yellow or yellow-orange colored foods, soft Hives, rash, asthma
drinks, medicine
Hives, rash, asthma
Soft drinks and some cheeses, salt-free
margarines, and processed potato products
Acute asthma and anaphylaxis, loss of
Shrimp,many processed foods avocado, instant, consciousess
pottasium potatoes, dried fruits, vegetables ,acidic juices ,

Reactions to Microbial Contamination of Unrefrigerated scombroid fish Scromboid fish poisoning

Foods (Tuna,bonita,mackerel) ,heat-distable toxin (itching,rash,vomiting,diarrhea)
Proteus causes histidine to break down to a produced
histamine-like substance (anaphylactic type 100
reaction)
Biogenic amines

 Regulate immune, digestive,

circulatory, muscular, and other
system
 Vasoactive amines alter permeability
and contractibility of blood vessels
(fluid balance, blood pressure &
cardiac work
101
Biogenic amines

 Monoamine oxidase (MAO) catabolize

and inactivate biogenic amines
 Biogenic amines: Histamine, Tyramine,
Octopamine, Phenylethylamine,
serotonin, dopamine, epinephrine,
norepinephrine

102
Cause of sensitivity to
biogenic amines
 Genetic: lack of monoamine oxidase
(MAO)
 Monoamine oxidase inhibitor (MAOI):
antidepressant, isoniazid (anti TBC)
 Food fermentation/unfresh (spoiled) food
: microbial enzymes convert amino acid
histidine to histamine
 Symptoms = Food allergy
103
Attention deficit disorder
with hyperactivity
 Studies have addressed the role of food
allergy and intolerance in learning and
behavioral disorder in children
 Food allergy produce inflammatory
mediators that affect CNS and behavior
 Food additive also affect CNS and
behavior

104
Migraine triggering foods
 Milk---------------43%
 Chocolate-------29%
 Cheese----------14%
 Fish---------------10%
 Wine--------------9%
 Coffee------------9%
 Garlic-------------5%
 Eggs--------------5%
105
OBESITAS ANDROID & OBESITAS GYNECOID
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