ALERGI

(REAKSI HIPERSENSITIFITAS)
MEIRINA DWI LARASATI
PENGERTIAN

 Kegagalan kekebalan tubuh di mana tubuh

seseorang menjadi hipersensitif dalam bereaksi
secara imunologi terhadap bahan-bahan yang
umumnya imunogenik (antigenik)
Penyebab:

- tanaman beracun
- bulu binatang
- getah
- lebah
- kacang dan kerang
- serbuk bunga
- debu
- jamur
JENIS

Berdasarkan mekanisme dan waktu yang dibutuhkan untuk reaksi,

hipersensitivitas terbagi menjadi empat tipe

Reaksi Hipersensitivitas Tipe I

Reaksi Hipersensitivitas Tipe II

Reaksi Hipersensitivitas Tipe III

Reaksi Hipersensitivitas Tipe IV

Reaksi Hipersensitivitas Tipe I

Hipersensitifitas tipe I disebut juga sebagai hipersensitivitas langsung atau

anafilaktik

Hipersensitivitas tipe I diperantarai oleh imunoglobulin E (IgE)

Komponen seluler utama pada reaksi ini adalah basofil. Reaksi ini diperkuat
dan dipengaruhi oleh keping darah (trombosit), neutrofil, dan eosinofil

Reaksi ini berhubungan dengan kulit, mata, nasofaring, jaringan

bronkopulmonari, dan saluran gastrointestinal

Reaksi ini dapat mengakibatkan gejala yang beragam, mulai dari

ketidaknyamanan kecil hingga kematian

Waktu reaksi berkisar antara 15-30 menit setelah terpapar antigen, namun
terkadang juga dapat mengalami keterlambatan awal hingga 10-12 jam.
Reaksi Hipersensitivitas Tipe I
DAMPAK REAKSI HIPERSENSITIVITAS TIPE 1

• batuk, mata berair, bersin karena alergen masuk ke

Anafilatoksis saluran respirasi (alergi rhinitis)
• Terakumulasinya mucus di alveolus paru-paru dan
local (alergi kontraksi otot polos kontraksi yang mempersempit
jalan udara keparu sehingga menjadi sesak.
atopik) • Kulit memerah atau pucat, gatal (urticaria) karena
alergi makanan.

• Sulit bernafas, karena kontraksi otot polos yang

menyebabkan tertutupnya bronkus paru-paru, dilatasi
Anafilatoksis arteriol sehingga tekanan darah menurun dan
meningkatnya permeabilitas pembuluh darah sehingga

sistemik cairan tubuh keluar ke jaringan.

• Gejala ini dapat menyebabkan kematian karena
tekanan darah turun drastis dan pembuluh darah
collapse (shock anafilatoksis)
Reaksi Hipersensitivitas Tipe I

DIAGNOSIS
Tes kulit

Uji ELISA untuk mengukur IgE total dan antibodi IgE spesifik untuk
melawan alergen yang dicurigai.

Peningkatan kadar IgE merupakan salah satu tanda terjadinya alergi

Namun, peningkatan IgE juga dapat dikarenakan beberapa penyakit,

seperti infeksi cacing, mieloma
Reaksi Hipersensitivitas Tipe I
PENGOBATAN REAKSI HIPERSENSITIVITAS TIPE 1

•Menghindari allergen dan makanan tertentu.

•Bila allergen sulit dihindari (debu, spora) gunakan
antihistamin untuk menghambat pelepasan histamine dari
sel mastosit.
Anafilatoksis •Bila terjadi sesak nafas pengobatan dapat berupa
bronkoditalor dan ekspektoran.
local •Injeksi allergen secara berulang dgn dosis tertentu secara
subkutan dengan harapan pembentukan IgG meningkat
sehingga mampu mengeliminasi allergen sebelum allergen
berikatan dengan IgE pada sel mast (disebut desensitisasi
atau hiposensitisasi)

Anafilatoksis •Menyuntikan epinefrin (meningkat-kan tekanan darah) atau

antihistamin (memblokir pelepasan histamine) secara
sistemik intravena
Reaksi Hipersensitivitas Tipe II

 Reaksi tipe II merupakan reaksi sitotoksik yang diinduksi oleh

kompleks komplemen dengan antibodi sitotoksik IgM atau IgG.
 Reaksi ini terjadi sebagai respon terhadap obat yang mengubah
membran permukaan sel.
 Contoh reaksi ini adalah anemia hemolitik yang disebabkan oleh
metildopa dan penisilin, ataupun trombositopenia yang disebabkan
oleh kuinidin.
 Obat lain yang bekerja melalui mekanisme ini antara lain sefalosporin,
sulfonamida dan rifampisin.
Reaksi Hipersensitivitas Tipe III

Merupakan reaksi hipersensitivitas yang dipicu oleh terbentuknya kompleks antigen dan
antibodi

Hipersensitivitas tipe III merupakan hipersensitivitas kompleks imun yang disebabkan

adanya pengendapan kompleks antigen-antibodi yang kecil dan terlarut di dalam jaringan.

Pengendapan kompleks antigen-antibodi tersebut akan menyebar pada membran sekresi

aktif dan di dalam saluran kecil sehingga dapat memengaruhi beberapa organ, seperti
kulit, ginjal, paru-paru, sendi, atau dalam bagian koroid pleksus otak

Gejala: demam, nyeri, malaise. gatal, edema, pengurangan komplemen di dalam darah,
glomerulonephritis (ginjal), arthritis (persendian), rheumatik penyakit jantung

Pengobatan: obat anti-inflamasi/antihistamin dan menghindari sejumlah besar antigen

Reaksi Hipersensitivitas Tipe IV

Hipersensitivitas tipe IV dikenal sebagai hipersensitivitas yang diperantarai sel

atau tipe lambat (delayed-type).

Reaksi ini terjadi karena aktivitas perusakan jaringan oleh sel T dan makrofag.

Waktu cukup lama dibutuhkan dalam reaksi ini untuk aktivasi dan diferensiasi sel
T, sekresi sitokin dan kemokin, serta akumulasi makrofag dan leukosit lain pada
daerah yang terkena paparan.

Contoh: hipersensitivitas pneumonitis, hipersensitivitas kontak (kontak

dermatitis), dan reaksi hipersensitivitas tipe lambat kronis (delayed type
hipersensitivity, DTH)
Food allergy vs food intolerance???
 What is the difference between food
allergy and food intolerance?

• Food-hypersensitivity can
Food involve the immune system (the
allergy body’s defence against attack)
and is called a food allergy.

Food • If it doesn’t involve your

immune system, the reaction is
intolerance called food intolerance.
Classification of adverse reactions to foods
Food allergy
Food allergy refers to an abnormal immunologic response to a food that occurs in
a susceptible host

Food allergies, defined as an immune response to food proteins

it usually involves the production of IgE, followed by the release of substances

such as histamine, causing the classic symptoms related to food allergies

Diagnosis of IgE-mediated food allergy is based on history, objective

examination, allergy tests, elimination diets and challenge tests.

Infants and children with a family history of allergy (eg eczema, hay fever,
asthma) may be more susceptible to food allergy, and symptoms are easy to
recognise and usually occur within minutes to one hour after eating the food

The main tests are: IgE blood tests or Skin Prick Tests
Pathogenesis food allergies

Food allergy is an immunological reaction against a food allergen:

• Diagnosed by detection of food-specific IgE.

• egg,milk, peanut, tree nuts, fish, shellfish, wheat, and soy.
IgE mediated • “major” food allergens are that they are water-soluble
glycoproteins, are 10 to 70 kD in size, and are relatively
stable to heat, acid, and proteases.

Not-IgE mediated • Absence of demonstrable food-specific IgE antibody in the

skin or serum.
(i.e. cell mediated) • Eosinophils and T cells seem to play a major role.

Mixed IgE and not-

IgE mediated.
Symptoms Food allergies

 Local swelling, itch and burning around the mouth

and throat are common symptoms and may be
followed by nausea, vomiting, tummy ache and
diarrhoea.
 Eczema in young children
 Symptoms can vary in severity and can in the worst
case lead to life threatening anaphylaxis
Which foods are involved?
Children:
 Children, the most common food allergens(90% of all
allergic reactions ) are:
 1. Cow’s milk
 2. Chicken eggs
 3. Shellfish – especially prawns
 4. Fish
 5. Soy
 6. Peanuts
 7. Wheat
 8.Tree nuts e.g. hazelnuts, almonds, walnuts, Brazil
nuts, cashew and pistachio nuts
Adults:
 Known as oral allergy syndrome, this type of food
allergy happens in people who have IgE antibodies to
pollen, and reacts to the proteins in fruits and
vegetables which are very similar to the pollen
allergens.
 The most common foods involved are apples, stone
fruit (peaches, plums cherries, etc) and tree nuts,
especially hazelnuts.
 Fish, shellfish, peanuts, legumes and seeds are also
common causes of allergy in adults.
ALERGI MAKANAN
• Alergen : glikoprotein

Alergi • 5 jenis alergen dalam susu sapi : BSA (Bovin Serum Albumin), BGG
(Bovin Gama Globulin), ALA (Alpha Lact Albumin), BLG (Beta Lacta
Globulin) dan casein

susu sapi
• Dampak klinis: Cow’s milk sensitive enteropaty, Cow’s milk induced
colitis, Eosinofilic gastroenteropaty, rhinitis alergika, asma, Urtikaria
akut, angioederma, dermatitis atopic, anafilaksis (alergi cepat dan
parah)

• Alergen pada putih telur: ovalbumin, ovomucoid dan ovotransferin

Alergi
• Alergen pada kuning telur: ovotransferin 15%, ovalbumin dan
ovomucin
• Telur yang dimasak akan mengurangi alergenitas 70%. Tapi

telur
ovomucoid resistant terhadap panas
• Dampak klinis: Reaksi cepat : rash eritematous disekitar mulut,
bengkak, urticaria mukosa mulut dan muka oedem, conjungtivitis,
rhinitis, muntah, diare dan reaksi anafilaksis. Reaksi lambat :
mencetuskan asma dan eksim atopik.
Managing food allergies

 Proven therapy is food

elimination.
 Labeling of food for
common allergies.
 Avoidance of all
allergenic food.
Food intolerance

Food intolerance is a ‘chemical’ reaction that some people have

after eating or drinking some foods.

Food intolerance reactions are usually related to the amount of the

food consumed

it is not an immune response and has been associated with asthma,

chronic fatigue syndrome and irritable bowel syndrome (IBS).

Food intolerance is much more common than food allergy.

Food intolerances do not involve the immune system and are rarely
life-threatening
Food intolerance
 Food intolerance occurs when chemicals in food (which
can be either naturally occurring or artificial) irritate
the body, similar to the side effects of some drugs.
 Food intolerances are principally caused by enzymatic
defects in the digestive system, as is the case with
lactose intolerance
 Lactose intolerance, which occurs because these
individuals have either too little or no lactase  the
enzyme which helps to digest milk sugar lactose.
Enzymatic food intolerance
 resulting from enzymatic defects of the gastrointestinal
tract.
 symptoms manifest in the gastrointestinal tract after
ingestion of certain foods.
 b-galactosidase deficiency common in adult populations.
 b-galactosidasedeficiency lactose cannot be completely
hydrolysed and the molecules reach the colon where they
are degraded by bacteria in H2O, CO2 and H2.
 The fermentation in the colon causes disturbances such as
bloating, abdominal pain and sometimes diarrhoea.
Undefined intolerance

 resulting from non-identified mechanisms, such as

food additive reactions.
 show intolerance reactions : sulphites, nitrites,
nitrates, monosodium glutamate and some
colourings.
 Possible symptoms are asthma, rhinitis, urticaria,
itchiness, and migraines.
Which foods are involved?

 Foods containing sugars (lactose, fructose,

sorbitol), and gluten are the most common cause
of problems.
 Vaso-active amines (found in red wine, strong
and blue cheeses, tuna, mackerel, pork
products, sundry and other foods).
 Chemical naturally foods such as salicyalte,
monosodium glutamate (MSG ) and some food
additives, especially the benzoate and sulphite.
Symptoms food intolerance

 Symptoms of abdominal bloating, nausea, diarrhea,

gas, cramps, or weight loss.
 Less common symptoms include shock, rash, hives,
generalized swelling, wheezing, inflamed
eyes/nose/sinuses, vocal cord swelling, and migraine,
headache.
 symptoms appear within a few minutes of eating the
particular food and can take up to 3 days.
 sensitive people, food chemicals (natural or artificial)
may build up over days or weeks and cause a chronic
or recurrent symptom.
Managing food intolerance

 Elimination diet and challenge is usually necessary to

confirm a diagnosis, and you will need to seek help from a
dietitian to ensure the diet remains nutritionally
adequate.