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1、Food intolerance and thefood industryEdited byTaraneh DeanPublished by Woodhead Publishing LimitedAbington Hall,AbingtonCambridge CB1 6AHEnglandPublished in North and South America by CRC Press LLC2000 Corporate Blvd,NWBoca Raton FL 33431USAFirst published 2000,Woodhead Publishing Limited and CRC Pr

2、ess LLC?2000,Woodhead Publishing LimitedThe authors have asserted their moral rights.Conditions of saleThis book contains information obtained from authentic and highly regarded sources.Reprinted material is quoted with permission,and sources are indicated.Reasonableefforts have been made to publish

3、 reliable data and information,but the authors andthe publishers cannot assume responsibility for the validity of all materials.Neither theauthors nor the publishers,nor anyone else associated with this publication,shall beliable for any loss,damage or liability directly or indirectly caused or alle

4、ged to becaused by this book.Neither this book nor any part may be reproduced or transmitted in any form or byany means,electronic or mechanical,including photocopying,microfilming andrecording,or by any information storage or retrieval system,without prior permissionin writing from the publishers.T

5、he consent of Woodhead Publishing Limited and CRC Press LLC does not extendto copying for general distribution,for promotion,for creating new works,or forresale.Specific permission must be obtained in writing from Woodhead PublishingLimited or CRC Press LLC for such copying.Trademark notice:Product

6、or corporate names may be trademarks or registeredtrademarks,and are used only for identification and explanation,without intent toinfringe.British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library.Library of Congress Cataloging-in-Publicat

7、ion DataA catalog record for this book is available from the Library of Congress.Woodhead Publishing Limited ISBN 1 85573 497 4CRC Press ISBN 0 8493 0853 4CRC Press order number:WP0853Cover design by The ColourStudioProject managed by Macfarlane Production Services,Markyate,HertfordshireTypeset by M

8、HL Typesetting Limited,Coventry,WarwickshirePrinted by T J International,Padstow,Cornwall,EnglandRelated titles from Woodheads food science,technology andnutrition list:Food labelling(ISBN:1 85573 496 6)J Ralph BlanchfieldFood labelling has become a complex and controversial area.This collection dra

9、ws onthe experience of key experts in their field to provide food manufacturers with aframework within which to plan labelling effectively.It covers both the key legislationthey need to be aware of,and the issues they need to take account of in successfullabelling.Principles and practices for the sa

10、fe processing of food(ISBN:1 85573 362 5)H J Heinz CompanyThis food industry handbook is a practical,science-based guide to food safety in foodprocessing operations.The text is organised for easy reference,illustrated withnumerous schematics and includes important reference data tables.readers will

11、want to have this book,not just because it is such a comprehensivetext on safe processing,but it is so full of sound advice.For food companies workingon HACCP programmes,this book is a must-have.Food Engineering.Instrumentation and sensors for the food industry(ISBN:1 85573 363 3)E Kress-RogersThe f

12、ood industry is placing an increasing emphasis on measuring,controlling andimproving food quality;selecting the correct instrumentation is central to this process.This book provides an authoritative and practical guide to the range of instrumentationand sensors available to the food industry profess

13、ional.Topics covered include colour,texture and rheological measurement as well as composition and microbiologicalanalysis.International experts have presented their knowledge in an applied framework toprovide the most comprehensive workbook for practitioners ever written.FoodScience and Technology

14、Abstracts.Details of these books and a complete list of Woodheads food science,technologyand nutrition titles can be obtained by:visiting our web site at www.woodhead-contacting Customer Services(e-mail:saleswoodhead-;fax:+44(0)1223 893694;tel:+44(0)1223 891358 ext.30;address:Woodhead PublishingLtd,

15、Abington Hall,Abington,Cambridge CB1 6AH,England)If you would like to receive information on forthcoming titles in this area,please sendyour address details to:Francis Dodds(address,tel.and fax as above;e-mail:francisdwoodhead-).Please confirm which subject areas you areinterested in.List of contrib

16、utors.ixList of abbreviations.xi1Introduction.1T.Dean,The David Hide Asthma and Allergy Research Centre,Isle of Wight1.1Background.11.2Terminology.21.3Mechanisms of food intolerance and food allergy.41.4Mechanisms of oral tolerance.81.5Summary.91.6References.102The legal context:due diligence.13M.La

17、w,Law Laboratories Limited,Birmingham2.1Introduction:the law and food intolerance.132.2The legal background:the Food Safety Act 1990.142.3The legal background:labelling.152.4The legal background:the control of food manufacture.172.5General product safety.172.6Civil remedies:the Consumer Protection A

18、ct.192.7Due diligence.192.8The practical application of due diligence to food allerginicity222.9The future.252.10Summary.26Contents3Diagnostic tests.27B.J.Bateman,The David Hide Asthma and Allergy Research Centre,Isle of Wight3.1Introduction.273.2The clinical history and examination.303.3Diagnostic

19、tests.353.4Food challenges.363.5Skin testing.393.6Patch testing.413.7Laboratory tests.433.8Other useful tests.473.9Unproven and inappropriately applied tests.483.10Summary.503.11References.504Symptoms of food intolerance.53J.OB.Hourihane,Institute of Child Health andGreat Ormond Street Hospitals,Lon

20、don4.1Introduction.534.2How to distinguish intolerance from allergy.534.3Oral allergy syndrome.554.4Evolution of allergic reactions.564.5Clinical categorisation of allergic reactions.564.6Anaphylaxis.594.7Other symptoms of food-related disease.624.8Summary.634.9Sources of further information and adv

21、ice.634.10References.645The treatment of food intolerance.67S.H.Arshad,The David Hide Asthma and Allergy Research Centre,Isle of Wight5.1Introduction:the range of treatments.675.2Avoidance therapy.685.3Hypoallergenic foods.745.4Drug treatment.775.5Treating the immediate symptoms.805.6Treatment of co

22、mmon food allergic diseases.845.7Summary:trends in treatment.875.8Sources of further information and advice.895.9References.89viContents6Sources of information and labelling.91F.Angus and J.Smith,Leatherhead Food Research Association6.1Introduction.916.2The UK Food Intolerance Databank.926.3The Dutc

23、h Food Intolerance Databank(ALBA).946.4European food intolerance databanks.946.5Other international databanks.966.6Food labelling in Europe:an outline.976.7Current and proposed labelling requirements for ingredientscausing hypersensitivity.996.8Future labelling trends.1056.9Sources of further inform

24、ation and advice.1067Analytical techniques for detecting food allergens.109S.Kilburn,Queen Alexander Hospital,Cosham7.1Introduction.1097.2The physical and chemical nature of food allergens.1107.3Principles of food allergen detection techniques.1127.4Processing and effects on allergenicity.1187.5Summ

25、ary.1187.6References.1198Handling food allergens in retail and manufacturing.121J.Hignett,Nestle UK Ltd,Croydon8.1Introduction.1218.2Identification of allergens.1228.3Good Manufacturing Practice.1238.4Control of allergens throughout the supply chain.1268.5Other initiatives.1328.6Key aspects of legis

26、lation from a manufacturing view.1328.7Labelling and promotion.1348.8Additional communication initiatives.1388.9Summary.1398.10Sources of further information and advice.1408.11References.1419Support organisations for individuals with food intolerance.143D.Reading,The Anaphylaxis Campaign,Fleet9.1Int

27、roduction.1439.2Current support organisations.1459.3Collaboration with governments.1489.4Collaboration with the food industry:retail and manufacturing.1509.5The use of disclaimers on food labels.1539.6The catering industry.155Contentsvii9.7Coeliac disease.1589.8Research into allergy and intolerance.

28、1589.9Summary.1599.10Sources of further information and advice.16110The epidemiology of adverse food intolerance.163A.Khakoo,G.Roberts and G.Lack,St.Marys Hospital,London10.1Introduction.16310.2Methodological issues.16310.3Commonly reported food allergies.16910.4Geographical variations.18810.5Cross-

29、reactions between foods.19310.6Occupatonal food allergy.19610.7Risk factors for the development of adverse food reactions.19710.8Intervention strategies aimed at preventing adverse foodreactions.20010.9Conclusions.20810.10 References.210Index.221viiiContents1.1BackgroundThe documentation of food int

30、olerance goes back to 55BCwhen Lucretius,adistinguished Latin poet and philosopher,wrote his poem De Rerum Natura(Onthe Nature of Things)and said What is food for some,may be fierce poison forothers.Hippocrates recognised the adverse effects of milk on some individuals whenhe noted:Cheese does not h

31、arm all men alike;some can eat their fill of it withoutthe slightest hurt.Others come off badly.So the constitutions ofthese men differ,and the difference lies in the constituent of the bodywhich is hostile to cheese,and is roused and stirred to action under itsinfluence.But if cheese were bad for t

32、he human constitution withoutexception,it would have hurt all.In 1808 Robert Willan described a case where a severe allergic reaction wasprovoked by eating a small amount of almonds:These symptoms were soon followed by an oedematous swelling of theface,especially of the lips and nose,which were very

33、 hot and itchy.There was at the same time an uneasy tickling sensation in the throat,which excited a troublesome cough and a constriction of the fauces,which seemed to threaten suffocation.The tongue,likewise,became en-larged and stiff,causing slowness and faltering in the speech.Soon aftergoing to

34、bed an eruption took place over the whole body of spots nearlyas large as a sixpence,of a dead white colour,a little elevated above theskin,like weals produced by the sting of a nettle,and intolerably itching.1IntroductionT.Dean,The David Hide Asthma and Allergy Research Centre,Isleof WightThere are

35、 many such anecdotes in medical history literature.What isnoteworthy is that,unlike most other disciplines where scientific research startssoon after such anecdotes,in the food intolerance area there has been a large gapbetween the case reports and scientific investigation of the field.This hascreat

36、ed opportunities for many people to blame food intolerance for a widerange of unexplained disorders,and for many years food intolerance wasregarded to be on the fringe of scientific enquiries.The fact that for decades thediagnosis of food intolerance relied mainly on clinical history created manyopp

37、ortunities for individuals and groups offering all sorts of unscientific andbizarre tests for diagnosis of food intolerance.It is only fairly recently,with theintroduction of double-blind placebo-controlled food challenges,that opportu-nities for more scientific approaches have been created and rese

38、arch into thisarea has provided us with good quality evidence.Just as high quality research evolved in the midst of anecdotes,theterminology in this field also evolved,and terms such as food hypersensitivity,food intolerance,food allergy and adverse reactions to food are used at timesinterchangeably

39、.In the next section,some of these terms are described in moredetail.1.2TerminologyWhen reading different texts in this area,it becomes evident that in the medicaland scientific community,there is no single global consensus on what is foodallergy and what is food intolerance.For example,there are au

40、thorities whoconsider coeliac disease as a type of food allergy and others who regard it as aform of food intolerance.Some may not consider it as either.Indeed,it appearsthat it all depends on what definition one has used.The terminology whichappears to have gained credibility amongst many peers is

41、that adopted by theEuropean Academy of Allergology and Clinical Immunology(EAACI).1Thedistinguishing feature of this terminology is that it is based on mechanismsrather than clinical symptoms.The structure of this terminology is outlined inFig.1.1.Broadly,adverse reactions are divided into toxic and

42、 non-toxicreactions.1.2.1Toxic food reactionsIn principle,these are reactions which could occur in any individuals if the doseis high enough to trigger a reaction.They are usually caused by direct action offood components without involvement of immune mechanisms.Toxiccompounds which trigger such rea

43、ctions can occur naturally,such as fromeating a puffer fish complete with its poison sac!Or they can be contaminants offood.Although such reactions are fairly distinguishable from non-toxic foodreactions in terms of mechanism,one has to be careful when diagnoses aremade,since some of the symptoms ma

44、y be similar.2Food intolerance and the food industry1.2.2Non-toxic food reactionsThese reactions are either immune-mediated or non-immune-mediated.Whenthe reaction is immune-mediated the term food allergy is applied,and whennon-immune-mediated the term food intolerance is recommended.Bothtypes of re

45、actions are reproducible and depend on an individualssusceptibility.Food allergyFood allergy itself can be subdivided into two categories,IgE-mediatedfood allergy and non-IgE-mediated food allergy(Fig.1.1).Immunoglobulin(Ig)E,or IgE,is the main antibody involved in induction of immediateallergic rea

46、ctions.Most of the research evidence available on food allergyhas been focused on IgE-mediated food allergy.Indeed,most common foodallergies are mediated by IgE antibodies.The mechanism underlying IgE-mediated food allergy is fairly well established.Symptoms of this form offood allergy appear rapidl

47、y,are varied and range from anaphylaxis to skinreactions.2Non-IgE-mediated food allergy is less well understood.Such allergiesinclude reactions involving other immunoglobulin isotypes such as IgG and itssubclasses,food immune complexes and cell-mediated immunity.Diagnosingthis form of food allergy h

48、as been difficult and none of the above-mentionedmechanisms have been proven to be causative by double-blind,placebo-controlled food challenges(DBPCFC).Fig.1.1Classification of adverse reactions to food.Introduction3Food intoleranceFood intolerance reactions are reproducible non-immune-mediated reac

49、tionswhich,depending on their causality,are divided into the following types ofintolerance:enzymaticpharmacological,i.e.reactions caused by either naturally derived or addedchemicals that produce a pharmacological effect in the individualundefined food intolerance.Lactase deficiency(usually referred

50、 to as lactose intolerance)is a goodexample of the enzymatic form of food intolerance.3It is often secondary toother conditions such as viral gastroenteritis.In very rare situations lactasedeficiency can be an inborn error of metabolism.Examples of pharmacological forms of food intolerance include r