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Dr. Fawzia abo ali Prof. of internal medicine & immunology Ain shams faculty of medicine

Dr. Fawzia abo ali Prof. of internal medicine & immunology Ain shams faculty of medicine

Dr. Fawzia abo ali Prof. of internal medicine & immunology Ain shams faculty of medicine

FoodFood AllergyAllergy andand FoodFood Intolerance:Intolerance:

What is the Difference?

Food Allergy:

– A response of the immune system involving antigen consisting of protein or a molecule linked to a protein

Food Intolerance

– A non immunologically mediated event, usually triggered by small molecular weight chemical substances, and biologically active components of foods

Histamine in Food Allergy

Histamine: is a physiologic protein, only active for a short time, released by mast cells & other granulocytes.

The main function of histamines is to protect the body against invaders such as allergens, bacteria and viruses. Histamines also promote wakefulness and alertness.

Histamine & food Intolerance

Histamine is a biologically active derivative of an amino acid (histidine)via histidine decarboxylase (HDC)

Is present in many foods and beverages

High doses are toxic to all humans : levels of >2.7 mg/kg body weight cause“histamine poisoning”

Individual tolerance determines reactivity to small quantities.

Individual Intolerance of Histamine

Cause is most likely a defect in the catabolism of

histamine.

In humans, enzymatic inactivation of histamine

occurs by two pathways:

Exogenous histamine is metabolised predominantly via oxidative deamination by DAO

Endogenous histamine is metabolised more via ring N- methylation by histamine N-methyltransferase

Mechanism of Histamine Sensitivity

Symptoms develop when:

Excessive amounts of histamine exceed the enzymes’ capacity to break it down There is a lowered enzyme capacity for histamine breakdown

Drugs inhibit enzyme action (e.g. isoniazid)

Theory of Histamine Excess

1.Histamine from dietary sources and from the activity of intestinal microorganisms will normally be catabolized before gaining access to circulation.

2. If enzyme activity is reduced, histamine will gain access to blood and augment the level of plasma histamine from endogenous sources.

Symptoms of Histamine Excess

Symptoms of Histamine Excess

Pruritis (skin, eyes, ears, nose)

Urticaria

Angioedema

Hypotension

Tachycardia

“Panic attack”

Chest pain

Nasal congestion

wheezes

Headache

Fatigue, confusion, irritability

Abdominal pain

Chest pain ♥ Nasal congestion ♥ wheezes ♥ Headache ♥ Fatigue, confusion, irritabilit y ♥ Abdominal

Sources of Histamine in Foods

1. Histidine can be decarboxylated to histamine (histidine decarboxylase )by intestinal bacteria

May develop in fish [especially tuna and mackerel that have been improperly processed and refrigerated.

In shellfish, where intestine is not removed

1. Histamine is produced by microbial action in manufacture of foods such as cheese, wine, beers, vinegar, yeast extract.

1. Histamine is produced by microbial action in manufacture of foods such as cheese, wine, beers,

Sources of Histamine in Foods

Sources of Histamine in Foods 3. Some foods contain high levels of histamine naturally, especially spinach

3. Some foods contain high levels of histamine naturally, especially spinach and eggplant

4. Plant foods may produce histamine during the ripening process, e.g. tomato

5. Some foods may release histamine by a non- immunologically mediated mechanism which is presently unknown. Such foods include:

mechanism which is presently unknown. Such foods include: • Egg white • Strawberry • Alcohol (ethanol)

Egg white

Strawberry

Alcohol (ethanol)

Citrus fruits

is presently unknown. Such foods include: • Egg white • Strawberry • Alcohol (ethanol) • Citrus

Other Food Sources of Histamine

Some food additives appear to release histamine:

Tartrazine and other azo dyes

Sulphites

Benzoates

Egg white (ovalbumin) has been implicated in histamine release by an unknown mechanism

Inhibitors of DAO and HMT

Drugs that inhibit enzymes involved in histamine breakdown result in histamine excess:

HMT inhibitors:

Antimalarial drugs

Anticancer drugs (pyrimidine analogs)

DAO inhibitors:

Copper-chelating agents .

Carbonyl group reagents (aminoguanidine)

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Signs of Possible Histamine Intolerance

1.

Skin tests:

“Mildly positive” to multiple allergens

Large reaction wheal to histamine control

2.

Unusually sensitive to alcoholic beverages

3.

Sensitive to fermented foods, cheese&vinegar

4.

Sensitive to benzoate-containing food.

5.

Dermatographia

6.

Indicators of reduced histamine metabolism:

Elevated plasma histamine (>2 ng/ml)

Reduced DAO activity (<0.7 nkat/L)

7.

Normal serum IgE.

Histamine poisoning

Histamine poisoning results from the consumption of foods, typically certain types of fish and cheeses, that contain unusually high levels of histamine. Spoiled fish of the families, Scombridae (e.g. tuna, mackerel, bonito), termed, “scombroid fish poisoning”, cheeses especially Swiss cheese, can be implicated in histamine poisoning.

termed, “scombroid fish poisoning”, cheeses especially Swiss cheese, can be implicated in histamine poisoning.

The symptoms of histamine poisoning include :

1.nausea, vomiting, diarrhea, 2.oral burning sensation or peppery taste, 3. hives, itching, red rash, and hypotension. 4.The onset of the symptoms usually occurs within a few minutes after ingestion of the implicated food, and the duration of symptoms ranges from a few hours to 24 h. 5.Antihistamines can be used effectively to treat this intoxication.

anagement of Histamine Intoleranc

anagement of Histamine Intoleranc

Management of Histamine Intolerance

1. Avoidance of foods that:

1. Contain high levels of histamine naturally:

Tomato Spinach Eggplant Histamine-rich fruits

Tomato ∑ Spinach Eggplant ∑ Histamine-rich fruits 1. Contain histamine as a consequence of manufacture :

1. Contain histamine as a consequence of manufacture:

Fermented foods and beverages

Cheese – Alcoholic beverages Vinegars – Fermented sausages

1. Contain histamine as a result of microbial activity :Non-gutted fish,Shellfish

2. Release histamine:Benzoates,Tartrazine .

2. Histamine Degrading Bacteria

Certain species of bacteria produce diamine oxidase:

– Lactobacillus sp. - Sarcina sp.

Capable of degrading food sources of histamine - May reduce total histamine load - Possible role in probiotics?

Histame is the first product worldwide that regulates histamine levels that can cause food intolerance

Histame is the first product worldwide that regulates histamine levels that can cause food intolerance by replenishing the body’s digestive enzyme Diamine oxidase, or DAO. Histame is not effective with immune system-