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• Understand a range of food intolerances and metabolic disorders • Explore the occurrence and manifestation of Celiac Disease. • Understand the major classes of food sensitivity. • Survey some examples of food • Anaphylactoid Reactions • Metabolic Food Disorders • Idiosyncratic Reactions • Not due to protein as food allergy • Overlapping classes • 1/3000 incidence • Not IgE-mediated • Delayed Type Hypersensitivity • 24-72 hrs post exposure • Ingestion of wheat, barley, rye • Proline-rich protein - gliadins • Triggers immune damage to small intestine • Impairs absorption of nutrients • Diarrhea, bloating, wt loss, bone pain, anemia, chronic fatigue, weakness, muscle cramps • Inherited trait – Chromosome 6 • Better classification may be idiosyncratic reaction • But involves immune component • Eating fish with high histamine levels • Histamine from spoilage bacteria in fish • Everyone is susceptible - allergy or just toxic??? • Same symptoms as food • Other factors besides histamine in fish that may exacerbate • Putrefactive amines - putrecine, cadaverine • Histaminase inhibitors - aminoquanine, isoniazid • Diamine oxidase inhibitors • FDA histamine action level • In absence of high histamine • Increased intake of biogenic amines • Increased synthesis of biogenic amines by gut flora • Diminished breakdown of biogenic amines by gut mucosa • Increased release of Case Study: Scombroid Fish Poisoning Pennsylvania, • On December 3, 1998, four adults became ill after eating tuna-spinach salad at the restaurant. • Symptoms of illness included a burning sensation in the mouth, a metallic taste, facial flushing, nausea, diarrhea, sweating, and headache; symptoms occurred approximately 5 minutes to 2 hours after eating the salad. • One patient was taken to the local emergency department and treated with diphenhydramine, cimetidine, and epinephrine. The other three patients were not examined by physicians and their symptoms resolved within a few hours. A presumptive diagnosis of scombroid fish poisoning was made based on clinical and epidemiologic features of the illness. Case Study: Scombroid Fish Poisoning Pennsylvania, • A sample of the remaining fish obtained from the restaurant was sent to PDOH for testing. The fish was positive for coliform and Escherichia coli, and tests were positive for histamine levels >50 ppm (fresh fish normally contain histamine levels of <10 ppm) using an enzyme-linked immunoabsorbent assay. • The wholesale-to-retail chain of events involved transporting the fish across national, state, and municipal borders and involved five transporters and four processors. The tuna was from a 40--60 lb yellow-fin tuna caught by a commercial fishing boat in the Gulf of Mexico during late November 1998. • The fish was caught using the long-line method, which uses a mainline up to 60 miles long with a series of suspended hook lines. The water temperature where the fish was caught was 78.5 F (25.8 C). Case Study: Scombroid Fish Poisoning Pennsylvania, • The catch of tuna was shipped from the fishing boat in iced vats by truck to a processor on November 24. The average temperature of the fish was 32 F--33 F (0 C-1 C). Of this catch, 785 lbs of tuna were shipped the same day to the wholesaler in Pennsylvania. The wholesaler received the shipment on November 27, and the average temperature of the fish was recorded as 36 F (2 C). • Three of these fish were delivered to the retail supplier; two large fillets, weighing 11.1 lbs each and noted to be in good physical appearance, were delivered to the restaurant on November 27. The fish was divided into 30 portions, kept in the freezer, and removed for thawing as needed for use. During November 28--December 4, 17 portions of the fish were served. The only four persons reporting illness ate the tuna-spinach salad on Dec 3. • No deviations in HACCP procedures in the wholesale-to-retail distribution of the tuna could be • Urticaria and anaphylactoid • No allergen identified • Strawberries do not contain histamine • Release of endogenous histamine • Not IgE-mediated • Genetically determined disorders • Affects host ability to metabolize food • Alters metabolic patterns that enhances host sensitivity to chemical • Lack B-galactosidase (lactase) • Metabolizes lactose to glucose and • Lactose cannot be metabolized • Bacteria in colon break down • 6-12% Caucasians • 60-90% Arabs, Greeks, Jews, Black Americans, Hispanics and • Can occur in children but more common • More severe in adults • Lactase in gut at birth • Caused by other intestinal problems • Failure to absorb lactose • Viral gastroenteritis • Intestinal damage • Disappears when gut heals • Oral administration of 50 g lactose to fasting person • Measure blood glucose or breath H2 • 50 g = liter of milk = high dose • Many people can handle smaller dose • More recent tests use smaller dose or gradually increasing doses • Some people have normal • Avoidance of dairy products • Complete avoidance not needed • Small divided doses of milk • lactose-hydrolyzed milk • Add lactase to milk • Yogurt and acidophilus • Inherited deficiency of glucose-6 phosphate dehydrogenase • Ingestion of fava beans (broad beans) or breathing pollen causes shortness of breath, nausea, abdominal pain, fever • Contain oxidants - vicine, convicine • G6PDH critical to rbcs • Helps maintain adequate levels of glutathione and NADPH which • Most common enzyme defect • 100 million people • Asians, Jews, Sardinians, Cypriot Greeks, African Blacks most – Inability to metabolize methanthiol, excreted in urine • Red wine - sneezing, itch, flush, headache, dyspnea Food Sensitivities: Idiosyncratic Reactions • Mechanisms unknown • Some well documented • Sulfites - asthma • Celiac disease - cereal products • Aspartame - urticaria • Chronic urticaria - BHA/BHT, benzoates • Asthma, urticaria - tartrazine • Migraine headache - aspartame • Aggressive behavior - sugar • Chinese Restaurant Syndrome • Hyperkinesis in children - food coloring agents • Prevent enzymatic and non-enzymatic browning • Antimicrobial, antioxidant • Dough conditioner • Bleaching agent • Triggered by exposure to sulfites • Acute onset - minutes • Can be severe - 20 deaths • Prevalence low - 1-2% asthmatics • Use on salad bars banned • Lettuce problem • Dried raisins/prunes - 500-2000 • Lemon/lime juices - 150-800 • Grape juices - 50-250 • Wine - 20-350 • Molasses - 125 • Shrimp - 10-100 • Must label if >10 PPM • Spans anaphylactoid, metabolic and idosyncratic • Some IgE-mediated • Some sulfite oxidase deficiency • Hypersensitivity to inhaled SO2 • Individual tolerance vary • Tartrazine = FD&C Yellow Dye #5 • Reports of asthma and urticaria in children • FDA required labeling in 1979 • Failure to list on label is most frequent cause of recalls today • Problems with studies • No effects on double-blind studies • Withholding medications - bronchioinhalers, antihistamines • Similar problems with other food additive studies and urticaria - flawed designs • FD&C Yellow dye # 5 • Sunset Yellow FD&C #6 • Sodium benzoate, benzoic acid • Parabens • BHA/BHT • Evidence for effects

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