Transcript Food Allergies and Intolerances and Their Importance to

Food Allergies and Intolerances
and Their Importance to the Meat
and Poultry Industry
Joe L. Baumert, Ph.D.
Food Allergy Research & Resource Program
University of Nebraska
[email protected]
www.farrp.org
Food Allergies
The food of one may be
poison for another.
Lucretius
De Rerum Natura
Food Sensitivities
(Individualistic Adverse
Reactions to Foods)
Food Allergy
Food Intolerance
Food Intolerances
• Anaphylactoid Reactions
• Metabolic Food Disorders
• Idiosyncratic Reactions
Anaphylactoid Reaction
• “Anaphylactoid” ≠ “Anaphylaxis”
• Certain foods can cause reactions that can mimic
symptoms of allergic reactions
• Probably associated with components of foods that
are small in size, but none have been identified
• Does this illness really exist?
–
ex. strawberry “allergy”
Metabolic Food Disorders
• Caused by exposure to a food component that
is toxic to certain individuals with genetic
defects in their ability to metabolize that
component
or
• The component has an unusual effect on the
host’s normal metabolism
Lactose Intolerance
• Associated with deficiency of intestinal lactase (bgalactosidase)
• Inability to metabolize lactose
• Disease worsens with advancing age
• Ultimately affects 60-90% in some ethnic groups
• Symptoms: abdominal pain, flatulence, frothy
diarrhea
• Treated with dairy product avoidance diets
Treatment of Lactose Intolerance
• Exclusion of all dairy products
• Consumption of dairy products with low lactose
levels including cheese and yogurt
• Divided doses of milk
• Lactose-hydrolyzed milk
Idiosyncratic Reaction
• An adverse reaction to a food or food
component among certain individuals occurring
through unknown mechanisms
Some Examples of
Idiosyncratic Reactions
Food
• Chocolate
• Tartrazine
• Sulfiting agents
• Food colors
Symptom
Migraine headache
Asthma
Asthma
Hyperkinesis
Food Additives
• Estimate 2,000 - 20,000 food additives
• Preservatives, sweeteners, stabilizers,
thickeners, colorings, flavorings,
conditioners, antioxidants
• Small number associated with adverse
reactions
Sulfites Used in Foods
• Sulfur dioxide (SO2)
• Inorganic sulfite salts that liberate SO2
– Na2S2O5 and K2S2O5 (metabisulfite)
– NaHSO3 and KHSO3 (bisulfite)
– Na2SO3 (sulfite)
– can occur naturally in foods
Adverse Reactions to
Ingested Sulfites
• Asthmatic – proven
• Nonasthmatic - controversial
– Hives, pruritus, angioedema, hypotension,
abdominal distress
– Most not substantiated by double-blind oral
challenge
Sulfite Sensitivity
• Asthmatic reactions
• Afflicts 150,000 people in U.S.
(1.7% of all asthmatics)
• Steroid-dependent asthmatics at greatest risk
(4-7% of these people are affected)
• Patients display thresholds (5-200mg K2S2O5)
• Patients react to some sulfited foods but not to others
• Foods having < 100 ppm total SO2 may not elicit
reactions
Adverse Reactions to Food
Additives-Conclusions
• Adverse reactions to additives are rare
• Most research studies are not well-designed
• Often, adverse reactions attributed to additives
are due to another cause
Food Sensitivities
(Individualistic Adverse
Reactions to Foods)
Food Allergy
Food Intolerance
Food Allergy
(Food Hypersensitivity)
IgE-Mediated
Cell-Mediated
Exercise-induced
Celiac Disease
Cell-Mediated Food Allergies

Delayed Hypersensitivity
– Reactions typically occur 6 – 24 hours after
ingestion of the offending food

Celiac Disease
– Celiac sprue, non-tropical sprue
– Gluten-sensitive enteropathy

Localized tissue damage resulting from GI
tract inflammation
Celiac Disease

Prevalence of at least 1 per 2000 in U.S.

Symptoms associated with malabsorption
(body wasting, anemia, diarrhea, bone pain, etc.)
– 20% do not have diarrhea symptoms

Associated with consumption of gluten
fractions of wheat, rye, barely, and
sometimes oats

Treatment: avoidance diets

Long-term sequelae (e.g. lymphoma)
Food Allergy
(Food Hypersensitivity)
IgE-Mediated
Cell-Mediated
Exercise-induced
Celiac Disease
IgE-Mediated Allergic Response:
Mechanism
Sensitization Phase
IgE-Mediated Allergic Response:
Mechanism
Elicitation Phase
Prevalence of Food Allergy

Perceived prevalence in the U.S.
– 1 in 5 Americans believe they have food allergies
– Many consumers do not differentiate between
IgE-mediated allergy and other food sensitivities
– Also accounts for a number of consumers who
experience oral allergy syndrome
Oropharyngeal itching, edema, urticaria
 Rarely associated with systemic reactions
 Fresh fruits and vegetables: peaches, apples, kiwi

Prevalence
• Between 3.5-4% of the U.S. population (or 1012 million Americans) have food allergy
– Sicherer, et al. J. Allergy Clin Immunol.
1999;103:559-62.
– Sicherer, et al. J. Allergy Clin. Immunol.
2004;114:159-165.
Prevalence of
Specific Food Allergies
in the U.S.*
Crustacean shellfish
Peanut
Tree nut
Fish
-
*Based on FAAN telephone surveys
1.9%
0.6%
0.5%
0.4%
Prevalence of
True Food Allergies
Infants/young children
Adults
-
4-8%
2-3%
Natural History of Food Allergy
• Most infants outgrow their allergy within
months
• Especially true if food allergy occurs before 3
years of age
• Some food allergies (ex. peanuts) are more
persistent than others (ex. milk, eggs)
Factors Involved in Development of IgEMediated Food Allergy
Sicherer and Sampson. J Allergy Clin Immunol. 2007; 120:491-503.
Most Common Causes of
IgE-Mediated Food Allergy
From: FAO Technical Consultation, Rome,
Italy (Nov., 1995)
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Cows’ milk
Egg
Crustacea
Fish
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Peanut
Soybean
Tree nuts
Wheat
Food Allergies Prevalence
Top Eight
90%
Peanut
Tree nuts
Milk
Egg
Soy
Fish
Shellfish
Wheat
Others
10%
Hundreds
of others
Commonly Allergenic Tree Nuts
November 2006 FDA List
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Almond
Beech nut
Brazil nut
Butternut
Cashew
Chestnut
Chinquapin
Coconut
Gingko nut
• Hazelnut (filbert)
• Hickory nut
• Lichee nut (litchi,
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•
•
•
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lychee, leechee)
Macadamia nut
Pecan
Pili nut
Pine nut (pinyon nut)
Pistachio
Shea nut
Walnut
Commonly Allergenic Tree Nuts
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Almond
Cashew
Brazil nut
Pistachio
Macadamia
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Walnut
Pecan
Hazelnut (filbert)
Pine nut (pinyon,
piñon)
Rarely Allergenic Tree Nuts
• Beech nut
• Butternut
• Chestnut
• Chinquapin
• Coconut
• Gingko nut
• Hickory nut
• Lichee nut
• Pili nut
• Shea nut
Other Foods That Cause
Allergic Reactions
• There are 160+ other foods that can cause
allergic reactions
Hefle et al. 1996. Critical Reviews in Food
Science and Nutrition 36:S69-S89
Allergenic Foods on Common
Allergen Lists in Other Countries
• Sesame seed – Canada, EU, Australia/ New Zealand
• Mustard – EU, Canada
• Celery – EU
• Molluscan shellfish – Canada, EU
• Lupine – EU
• Buckwheat – Japan, Korea
Typical Symptoms of
IgE-Mediated Reactions to Foods
Gastrointestinal
• nausea
• vomiting
• abdominal pain
• diarrhea
• Systemic
• anaphylactic shock
Cutaneous
• urticaria
• angioedema
• atopic dermatitis
• Respiratory
• rhinitis
• laryngeal edema
• asthma
Anaphylactic Shock
• A generalized shock reaction
• Can have multiple organ failure
• Can have any of the other symptoms in
addition to severe loss of blood pressure
and cardiac arrhythmia
• If not treated immediately, can be fatal
Food-Induced Anaphylaxis is
Not a Rare Occurrence

Food allergy is the most common cause of
anaphylaxis in U.S. emergency rooms (~30%)
– Yearly estimates
50,000 anaphylactic reactions
 2,000 hospitalizations
 100 – 150 deaths


Currently, no active treatment for food allergy
other than strict avoidance of the offending food
Allergic Reactions to Foods Can
Occasionally be Fatal
• Yunginger and co-workers, JAMA (1988)
– 8 deaths from inadvertent ingestion of allergenic foods
• adults and adolescents
• Sampson and co-workers, NEJM (1992)
– 12 deaths/near-deaths from ingestion of allergenic foods
• children
• Bock and co-workers, JACI (2001)
– 32 deaths from inadvertent ingestion of allergenic foods
• ages 2-33, with most victims adolescents or young adults
CASE #1
Age, sex:
18,F
Allergen:
Peanut butter in restaurant chili
Reaction:
Onset in minutes; death in one hour
Epinephrine: Subcutaneous, 20 min.; I.V. 40 min.
Autopsy:
Angioedema of lips, tongue, larynx,
pulmonary hyperinflation
CASE # 3
Age, sex:
Allergen:
19, F
Peanut-containing cookie;
dormitory party
Reaction: Onset in minutes; DOA within 1hr
Epinephrine:Two 0.5 ml doses during resuscitation
Autopsy:
Focal pulmonary hyperaeration;
terminal aspiration; no laryngeal edema
CASE #7
Age, sex:
31, M
Allergen:
Fish-contaminated restaurant french fries
Reaction:
Immediate onset; death within 2 hours
Epinephrine: Total 10 ampules during resuscitation
Autopsy:
Marked laryngeal edema
Gingersnap Case
Age, sex:
35, M
Allergen:
Peanut-contaminated gingersnap cookies
Reaction:
Onset 5 min.
Epinephrine:
Self-administered at onset and thirty min. later
Symptoms:
Bronchospasm, urticaria, abd. cramps,
tachycardia, peripheral cyanosis
Gingersnap Case (cont’d)
Dose:
20 cookies
Last exposure:
28 years previous
Occupation:
Allergist
Analysis:
22,000 ppm peanut
What Are the Causative Agents
of Food Allergies?
• Naturally-occurring proteins
• Heat-resistant
• Resistant to proteolysis
• Resistant to extremes in pH
• Usually major proteins of the food
• Foods can have 1 or many allergens in them
Treatment for
True Food Allergies
Specific Avoidance Diets
Problems with Specific
Avoidance Diets
• Degree of selectivity
• Knowledge of food composition
• Exquisite sensitivity
• Adequate nutrition
• Restaurant meals
• Confusing labeling terms
Exquisite Sensitivity of Some
Food-Allergic Individuals
• Trace amounts of the offending food will
trigger reactions
How Much is Too Much?
Milligram amounts!
(ppm concentrations)
Dose of Peanuts Causing Reactions in
Highly Sensitized Subjects
Lowest Eliciting Dose
Taylor et al. Food Chem Tox., 2011
How to Manage a Food Allergy
• Avoid offending food
• Label education and diligent reading
• Brand loyalty = safety
Possible Preparation
Errors/Oversights
• Using same utensils/containers
• Using same frying oil
• Lack of restaurant labeling
• Uninformed wait/cook staff
• “Creative” recipe formulation
• Tableside cooking
Possible Processing
Errors/Oversights
• Inadequate cleaning of shared equipment
• Use of re-work
• Switching of ingredients
• Formulation mistakes
• Wrong labels/packages
• Labeling terms
Where Risks Occur
• Research and Development
• Engineering and System Design
• Raw Materials/Suppliers/CoPackers/Purchasing
• Labeling and Packaging
Where Risks Occur
• Production Scheduling/Changeovers
• Rework
• Sanitation
• Human Error
Food Allergies and Sensitivities:
Conclusions
• Affect a small percentage of the population
• But, reactions can occasionally, be severe,
even life-threatening
Why the Increased Interest in
Food Allergies?
Food Industry
– Increased consumer awareness
– Potential impact of severe reactions
– Increased number of product recalls
– Increased attention by governmental regulatory agencies
– Threshold dose is very low
Food Allergies can be
Deadly Serious
Food Allergies
An issue of growing concern
An issue that is here to stay
An issue that has increasing international aspects
An issue that can be controlled
Current Status of
Food Allergen Issue
• Recalls continue to occur in high numbers; 2nd leading
cause in FDA Reportable Food Registry
• Some companies have improved allergen control and
decreased incidence of recalls
• USDA has increased interest in food allergens and
labeling
• Recent label reviews
• recent industry memo on high frequency of recalls
• Labeling has improved but . . . .???