allergy to food additives

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types and management of allergic reaction to food additives


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Dr. fawzeia abo ali Prof. Of int. medicine &clinical immunology Ain shams faculty of medicine Allergy to food additives

'food additive‘means any substance not normally consumed as a food by itself and not normally used as a typical ingredient of food. contaminants orsubstances added for nutritional qualities. : 

'food additive‘means any substance not normally consumed as a food by itself and not normally used as a typical ingredient of food. contaminants orsubstances added for nutritional qualities. does not include

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Types of food additives

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Preservatives (to give food a longer shelf-life) The Sulphites used to preserve processeed meats, and dried fruit According to the FDA, about 5 percent of asthmatics are sensitive to sulfites. Sodium nitrite, &benzoic acid These agents are added to food products and occur naturally in, cinnamon, tea and berries. They may cause urticaria, asthma and angioedema. (E 210 - E 219 )

Colourings (make food visually more attractive). : 

Colourings (make food visually more attractive). (tartrazine) is used to color beverages, candy and other foods. Nitrates and Nitrites - give meat a pink colour to look more attractive and found in frankfurters They can trigger hives, urticaria, asthma and generalized allergic reactions.  ( E 100 - E 180 )

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Antioxidants: (prevent fat rancidity) Synthetic phenolic antioxidants prevent this spoilage happening but can trigger asthma, rhinitis and urticaria. (E320 – 321) Flavour enhancers (to enhance palatability). Aspartame: a low calorie sweetener can trigger urticaria and itchy hives. Monosodium Glutamate (MSG) which can trigger the "Chinese Restaurant Syndrome" of headache and burning plus tightness in the chest.  ( E 620 - E 635 )

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Emulsifiers and stabilisers Stop oil and water components separating, as in ketchup and mayonnaise, Occasionally cause adverse reactions.

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Naturally occurring substances in food Vaso-active amines. Natural Histamine, Serotonin and Tyramine occur in some cheeses, fish, sausage, red wine, chocolate and pickled vegetables can induce cramping, flushing, headache and palpitations in a dose related manner. Caffeine found in foods, medication, tea, coffee and Coca-Cola induces dose dependent agitation, palpitations, nausea and tremors.

Salicylates (aspirin-like naturally occurring chemicals).Salicylates induce urticaria, asthma and nasal polyps. They are found in Curry powder, paprika, dried thyme,  oranges, apricots, honey, berries and fruit skins, tea and almonds.  Salicylate sensitive individuals also tend to have adverse reactions to benzoates and tartrazine

E numbers : 

E numbers

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E numbers are number codes for food additives and are usually found on food labels throughout the European Union. the 'E' prefix which stands for Europe. If a food additive has an E number this shows it has passed safety tests and been approved for use throughout the European Union.

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2.1 E100–E199 (colours) 2.2 E200–E299 (preservatives) 2.3 E300–E399 (antioxidants, acidity regulators) 2.4 E400–E499 (thickeners, stabilizers, emulsifiers) 2.5 E500–E599 (acidity regulators, anti-caking agents) 2.6 E600–E699 (flavour enhancers) 2.7 E700–E799 (antibiotics) 2.8 E900–E999 (miscellaneous) 2.9 E1000–E1999 (additional chemicals)

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(FDA) estimates 1 percent to 3 percent of adults and 6 to 8 percent of children may experience some sort of sensitivity to food additives.Adverse reactions to food additives could be of two different types: : 

(FDA) estimates 1 percent to 3 percent of adults and 6 to 8 percent of children may experience some sort of sensitivity to food additives.Adverse reactions to food additives could be of two different types: Intolerance : where no immunological basis is apparent. allergy or hypersensitivity, which results from an immunological mechanism.

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Signs and symptoms of additive sensitivity

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Skin urticaria/angioedema atopic dermatitis sweating itching flushing Gastrointestinal abdominal pain nausea/vomiting diarrhea Respiratory asthma symptoms cough rhinitis

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Musculoskeletal muscle aches joint aches fatigue weakness Neurologic behavior mood changes and bedwetting. attention deficit and hyperactivity disorder migraine headaches mood swings, difficulty falling asleep, frequent night waking, night terrors, restless legs Cardiac palpitations arrhythmias

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Anaphylactic shock. Can occur with sulfites. Without treatment, a severe reaction (anaphylaxis) may quickly progress to anaphylactic shock.

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adverse hyperactive behavioural changes in children have been documented with excess amounts of artificial food colourings and sodium benzoate preservatives . Melkersson-Rosenthal Syndromea rare disorder possibly triggered by sodium benzoate tends to occur in atopic individuals.characterised by lip granulomas, facial paralysis and a fissured tongue.  . Special consideration

diagnosis of allergy to food additives : 

diagnosis of allergy to food additives

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Diagnosis for additive sensitivity HISTORY: It is suspected when a person experiences various reactions to prepared foods or when eating at restaurants, but not from foods prepared at home. food diary The first step often involves an individual creating a complete food diary with the help of a physician.

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While keeping this diary, patients will be asked to record all the foods they consume, the time food is eaten and the time reactions occur. By closely observing which foods trigger a response, a physician can often pinpoint additives that are more likely to blame.

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Elimination diet an elimination diet, which involves avoiding any foods that may contain the problem additives. By observing the patient’s reactions or lack of reactions through this stage, the physician can further determine the individual’s susceptibility.

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Provocative Tests for Food or Food Additives The method includes administration of the food extract, followed by observation for any of a broad variety of subjective and objective signs and symptoms that could be interpreted as the presence of a food allergy.

Treatment : 


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Treatment and prevention of additive sensitivity there are no established treatment or prevention methods for additive sensitivities. However, if a person is diagnosed with an additive sensitivity by a physician, the most basic and effective way of preventing further reactions is: avoidance avoidance

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Ingredient lists must be carefully. Individuals with additive sensitivities should also learn to inquire at restaurants about cooking methods that might present a problem. A physician will often recommend anti allergic medications to provide relief for reactions . individuals who could potentially have an anaphylactic response should carry a syringe of epinephrine and know how to self-administer the medication.

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Reactions against additives are rising . Additives are responsible of a lot of adverse effects They are mainly due to intolerance, yet true allergy are evident in atopic individuals No accurate diagnostic tests are yet available. Always read all packaged food labels, it is now FDA ensured that additives must be clearly labeled. All additives used within the European Community must have an E number. General rules for preservatives and additives:

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References: A complete listing of food additives by E number is available at: (Accessed on May 12, 2008). Simon, RA, Bosso, JV, Daffern, PD, Ward, B. Prevalence of sensitivity to food/drug additives in patients with chronic idiopathic urticaria (CIUA). J Clin Immunol 1998; 101:S154. Asero, R. Food additives intolerance: a possible cause of perennial rhinitis. J Allergy Clin Immunol 2002; 110:937. McCann, D, Barrett, A, Cooper, A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007; 370:1560.

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