The term food allergy (food allergy) is part of a broader terminology, namely hipersensitivitas food (food hypersensitivity), as translated all the unexpected reactions that arise related to food, and can be differentiated:
1. Allergic to food (food allergy), which is associated with the reaction mechanism imunologis, and by the imunoglobulin E (IgE), or non-IgE.
2. Getting food (food intolerance), which is not by the mechanism imunologis. Intolerance occur as a result of the materials contained in food, such as toxins / poisons (such as food poisoning histamin the sea / fish), or use the farmakologis (for example tiramin in cheese or red wine). This reaction occurs in people who are very healthy even if the food was consumed in large doses. Unlike with food allergy, which occurs even if the food is quite small doses. The possibility of other causes of food intolerance is the congenital metabolic diseases (for example defisiensi enzyme laktase the cause of intolerance laktosa). Food intolerance is not discussed in this paper.
Prevalence
Food allergy occurs more frequently in children, compared with adults. Food allergy by the IgE, which occurred in 6% of children under 3 years, and 2% in adults. Children with allergic disease (atopi) such as eczema (dermatitis atopi) and asthma are more vulnerable to food allergy. More than 95% of food allergy relief on the types of food such as eggs, milk, beans, wheat, soybean, and fish. Reached the age of 5 years old, allergic to eggs, wheat, milk, soy and disappeared in most of the children. However allergic to nuts and seafood to survive in the age of 80% of adult children.
Clinical Overview
The following will explain the clinical picture that can be found in the food allergy Mediated IgE and non-IgE.
IgE Mediated Food allergy
This diagnosis was based on a thorough anamnesis complaints / symptoms are. Allergic reactions usually arise in 30 minutes after swallowing allergens, and cause one more signs and symptoms of the following:
- Skin: Natal, urtikaria, angioedema
- Gastrointestinal : vomiting, diarrhea, stomach pain
- Channel breath: cough, hoarse voice, stridor, use
- Circulatory hipotensi, fainting
Food allergy is not mediated IgE
Signs and symptoms appear several hours / days after swallowing allergens. Various is:
1. Enterokolitis syndrome triggered by a protein food. This difference arises in the baby milk cow or soy milk, or food cereals such as rice. Symptoms arise in the 1 - 3 hours after swallowing allergens, in the form of vomiting continuously bile colored liquids. Hipotensi occurred in 15% of cases, with symptoms of pale and weak, so often different diagnosis as sepsis. No symptoms rarely repeated until finally known as a cause of food allergy.
2. Enteropati triggered by the protein food. Symptoms appear in the form of infant diarrhea, vomiting, and failed to grow. Most often due to cow's milk protein, can also indirectly from soybeans, eggs, wheat, rice, chicken and fish.
Mixed IgE Food Allergy and Non-IgE (IgE Mixed IgE Mediated and Non-Food allergy)
Other allergic diseases experienced by this group:
1. Esofagitis Eosinofilik Alergika (Allergic Eosinophilic Esophagitis). Appears on the baby to teenagers, with symptoms refluks gastroesofagus chronicles not recover with the anti-drug refluks, namely: vomiting, do not want to eat, stomach pain, and exacting.
2. Gastritis Eosinofilik Alergika (Allergic Eosinophilic Gastritis). Can arise in infants up to teenagers, with symptoms after eating such as nausea, vomiting, stomach pain and do not want to eat, until obstruksi / sumbatan channel digested.
3. Gastroenteritis Eosinofilik Alergika (Allergic Eosinophilic Gastroenteritis). Occurred in all age with symptoms fail to grow (failure to thrive), body weight decreased, and the symptoms of gastritis and esofagitis.
4. Proktokolitis Eosinofilika (Eosinophilic Proctocolitis). Arise in infants due to the influx of protein food through breastmilk or formula milk in the cow / soy. Blood found in the feces, but the baby did not appear sick with good growth.
Diagnosis
Food Allergy mediated IgE
The existence of a specific food IgE antibodies can be detected with a skin test Prick (Skin Prick Test / PST) or blood (RAST - Radioallergosorbent test), which measures the rate of IgE antibodies specific allergens in the skin or blood. Prick skin test simple, fast, and not too expensive, but it should be done by doctors trained in the methodology and reading / interpretation of the results, given the false positive results (false positive) quite often. Negative results of this audit can be trusted enough (rare false negative). RAST test, while more expensive, with a limited number of akergen that can be examined at time . The results also can be obtained in one week.
Definitive diagnosis / allergic to certain foods to see the reaction was immediate from the exposure of food (and graded food challenge). This test can not be done at home, if there is suspicion that food allergy by the IgE.
Still there are some other techniques to test food allergy, haft, but have not yet recognized scientific, expensive, and can impact on the maturation against food-beverage that should not be.
Food allergy is not mediated IgE
Currently there are supporting the inspection / diagnostic specific to the syndrome hipersensitivitas food that is not mediated IgE. The only way is the avoidance / maturation certain types of food, followed by re-exposure (food challenge). Of the food is done with the supervision of a doctor who competence in allergy, and to ensure Feed nutrition also .
In a mixture of IgE syndrome / non-IgE, Prick skin test can be used. Endoscopic biopsy channel and indigestion can check, if the symptoms involve the sign-channel involvement digested.
treatment
There is no cure to food allergy. The only therapy that has proved successful is the strict avoidance (Strict avoidance) of food allergens are known. Patients and their parents taught how to read food labels packaged with right, and know the terms specific allergens and food products. Experts on nutrition / diet (dietisian) can be involved in this case.
Patients with hipersensitivitas food mediated IgE equipped with quality planning in case of immediate reaction / sudden allergic food unexpectedly, for example, using the tools adrenalin injection (EpiPen ® / junior EpiPen ®). This is done with the guidance of specialist doctors child, or allergy-immunology experts, including education and planning characteristic anafilaksis written.
Advanced Supervision (Follow-up)
Most of the allergic food (except nuts and fish / shellfish) lost itself over time, the patient is monitored regularly to see a reduction in allergy attacks, and plans if the situation occurred due to serious allergic-emergency.
Nutritional adequacy of each person also considered giving the supplements needed, for example kaslium supplements on children in the 12 months to avoid the consumption of cow's milk.
Also be given routine immunization schedule appropriate. MMR vaccination is safe in children with allergic to eggs, but influenza vaccination contraindication
Prevention of Food Allergies
Infants with high risk (for example: no history of allergy to the parents / family, which is significant), said the latest recommendations of exclusive breastfeeding for 6 months. Dietary restrictions (of food) during the breastfeeding mothers to prevent allergy is also not recommended. If the baby is consuming milk formula, the formula hidrolisis (milk protein, already split) recommended in infants with high risk. Formula hidrolisis part (partially hydrolysed formula) such as NAN HA ® can be purchased without a prescription, while all hidrolisis formula (extensively hydrolysed formula), for example Peptijunior ® can be obtained only by prescription, and its use limited to the baby proved allergic to cow's milk and soy. Although there is no evidence that describes the time when the start consuming solid food (solid foods), are often recommended to delay the introduction of solid food until the baby reaches the age of 6 months, and delay the nuts and fish / shellfish until the baby with a high risk age 3 - 4 years.
Kelirumologi General (Common Misconceptions)
Hiperaktivitas such behavior often associated with a food allergy, but there is no evidence.
Also, there is no evidence that the increase milk production of mucus , and avoidance of milk and wheat is only useful in patients who have proved allergic to this type of food.
