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Autism in children is a developmental disorder that appears at the age of under five (under three years), which causes them not able to form social relations or develop normal communication. The condition of abnormalities in children with autism may vary from mild to severe so it is said to be a spectrum disorder or Autism Spectrum Disorder (ASD). One of the abnormalities found in children with autism is a disorder of the immune system that underlies the existence of food allergies in these individuals. The immune system is largely located in or near the gastrointestinal tract to prevent entry of foreign objects into other parts of the body.
Effects on the immune system can lead to increased growth of certain microorganisms, one of which is the fungus Candida Albicans in the gastrointestinal tract. Damage to barrier defenses in the gastrointestinal tract causes increased feeding of food allergens. This will cause an allergic reaction with Ig E as a mediator. Menifestasi allergic diseases that arise can vary depending on the sensitivity of the patient. These allergy symptoms can also occur in several places simultaneously. Manifestations of allergic diseases can include digestive disorders, urticaria, and behavioral disorders as found in autism spectrum disorder.
TYPE OF IMUN DEFICIENCY IN CHILDREN AUTIS
Myeloperoxidase Deficiency
Myeloperoxidase is an enzyme encountered in white blood cells (neutrophils) that react hydrogen peroxide and chloride ions to form hypochlorite ions, an active substance similar to those contained in bleach commonly used in households. Hypochlorite ions kill the fungus as well as bleach used in the household. If this enzyme is deficient, white blood cells cannot produce hypochlorite ions to kill the fungus, resulting in excessive growth of fungus. Patients with this disorder often have fungal infections on the nails or may also have systemic fungal infections. Myeloperoxidase deficiency may be a genetic disorder or an acquired abnormality. These genetic abnormalities are associated with mutations in the chromosome pair 17 or associated with biotinidase deficiency. Abnormalities of the myeloperoxidase enzyme may be associated with heavy metal poisoning, folic acid deficiency or vitamin B-12, severe infections and leukemia.
Severe Immunodeficiency (Severe combined immunodeficiency disease (SCID)
In severe immunodeficiency, the abnormalities encountered are defects in T lymphocytes and B lymphocytes so that both immune and hormonal immunity is impaired. This disease may be associated with genetic abnormalities on the X chromosome or on one of the other chromosomes. Genetic disorders that cause a deficiency of purine enzyme nucleoside phosphorylase or adenosine deaminase also cause SCID. Candida Sp infection, often seen in these severe immunodeficiency diseases.
Selective Ig A Deficiency
This immunodeficiency occurs in one person from 600-1000 Europeans. The cause of Ig A deficiency is still unknown. In some cases, this immunodeficiency appears to be influenced by heredity but in some cases, it is not. In some cases, IgA deficiency is accompanied by abnormalities on chromosome 18, but in general, IgA deficiency is not accompanied by chromosomal abnormalities. Drugs or viral infections can cause IgA deficiency also are sensitive to gluten.
Also read : A Guide For Your Child Who Is Allergic To Food
Complementary Deficiency C4b
The complement system is a complex system consisting of 20 proteins called complement. Complement is part of the immune system that serves to destroy fungi, viruses, and bacteria. The complement system can integrate with cell membranes as a bacterial species and complementary results complement the white blood cells to destroy and clean up the remaining bacteria that have been destroyed.
Some complement components can envelop the bacteria so that the bacteria can be easily "eaten" by white blood cells. The concentration of complement C4b in autistic patients has decreased. Patients with C4b complement deficiency are easily infected by fungi and bacteria such as Streptococcus pneumonia and Haemophilus influenza, two bacteria that often cause ear infections.
Autoimmune disorders in Autistic Children
Patients with candidacies often produce antibodies against candidates that also react to various tissues of the human body such as the brain, kidneys, pancreas, spleen, thymus, and liver. Even these same mushroom antibodies are also reacting to wheat protein. This explains why antibody sisters against wheat proteins are very high in autistic children and why they are so sensitive to wheat protein. One major part of a wheat protein called alpha-gliadin is very similar to one part of the fungus protein involved in the reproduction of fungi.
Food Allergy Phenomenon in Autistic Children
Food allergies are one part of the food intersection. Food allergies can generally be defined as an excessive body immune system reaction (hypersensitive reaction) due to contact with food or food supplements (allergens) that do not cause any complaints about most normal people. Immune reactions in individuals who are allergic to excessive and cause damage to tissue and impaired function of the organs of the individual body concerned.
Human digestive tracts are thought to protest 100 tons of food during their lifetime and individuals in certain populations with food allergies are few. This is because the intestines in normal circumstances have a good defense system. The intestinal mucosa has an epithelium that acts as a physical barrier (barrier). This gastrointestinal barrier has defense function against various anti genes such as bacteria, virus, parasite and food protein/food allergen. They are: (1) an immunologic barrier that inhibits the penetration of food antigens / allergens, the specific IgA in the intestinal lumen blocking the removal of allergens from the intestinal lumen, (2) the immunologic barrier that cleans food antigens / allergens that successfully penetrate IgA, IgG specific, and endothelial reticule system. In addition, the gastrointestinal tract also has (1) physiologic barriers that break down antigens in the gastrointestinal tract, namely gastric acid, pepsin, pancreatic enzymes, intestinal enzymes and phytosterol activity of intestinal epithelial cells, and physiologic barriers that inhibit the penetration of antigens in the form of water intestinal mucus that can reduce mucosal contact with antigenic substances in the intestinal lumen.
As mentioned above, the immune system that is part of the intestinal barrier in children with autism has various disorders including (1) myeloperoxidase enzyme deficiency, which plays a role in suppressing the growth of fungi, (2) severe immune deficiency, with the effect on T lymphisite and lymphocytes B, so as not to overcome candida infections, (3) deficiency of IgA that protects along the gastrointestinal wall against exposure to foreign matter, and (4) complementary deficiency of C4b which is part of the immune system to destroy fungi, virus and bacteria. In addition, the digestive tract of children with autism suffered structural damage due to various toxic substances found in the environment. Deficiency of the immune system in the gastrointestinal tract will lead to increased growth of organisms such as fungi and the entry of foreign objects including food allergens into various other body parts. The development of fungi such as Candida albicans excessively in the digestive tract autism will cause chronic inflammation and increase damage to the intestinal barrier. This inflammation of the gastrointestinal tract is called inflammatory bowel syndrome (IBS). IBS in this autistic child is suspected as a persistent mobile viral infection in the MMR fax, one of the ASD triggers.
Also read : Easy Solution For Your Child's Food Allergy
Reaction of food intersection without IgE Mediator
Digestive enzymes in children with autism are also impaired. The most commonly disturbed digestive enzyme in autistic children is Dipeptidylpeptidase IV (DPP IV). DPP IV is a digestive function to break down peptide bond after proline carboxyl group so that DPP IV function disorder will cause indigestion of various proteins, so DPP IV function disorder will cause digestive disorders of various proteins. Thus the protein of cow's milk (casein) and wheat protein (gluten) will not be completely digested and only a peptide molecule alone called casomorphin and gluteomorphin. Casomorphin and gluteomorphin can be absorbed by the inflammatory tract of an inflamed autistic child and inside the brain acting as a fake neurotransmitter and binding to morphine receptors, resulting in behavioral disorders.
Allergy Tests
Anti-or antibodies specific to certain allergens are specific E-immunoglobulin (Ig E specific). These specific IgE antibodies circulate throughout the body including in the blood and under the skin tissue. The presence of this specific IgE in the patient's body can be proven through allergy testing. This allergy test consists of three kinds of skin tests, blood tests, and provocation tests. The skin test can be a skin puncture test, outboard skin test, and scratch skin test. Blood laboratory tests examining immunoglobulin E (IgE) and provocation tests in patients performed by giving suspected allergens to symptomatic organs in order to prove these suspected allergens are the cause of symptoms, but this provocation test cannot be done routinely.
Procedures for allergy tests with a skin puncture test
- At first, the forearm skin to be tested is cleaned with alcohol.
- Then the skin is stained with a number of allergens and stabbed with a small sterile needle. The puncture is very shallow and does not cause bleeding or pain.
- Allergen droplets are left for 15-20 minutes.
- After that, the allergen droplets are cleaned and the presence or absence of reddish bumps on the puncture area is then compared with negative and positive controls.
Note: This allergy test can be performed on healthy individuals aged 4 years or older and within 4 days of not taking antihistamine medication because these drugs will interfere with the examination of allergy tests.
Blood laboratory tests check for specific E-immunoglobulin (IgE RAST)
Blood laboratory tests examining specific E-immunoglobulin (IgE RAST) requires patient blood which is then examined in a radioactive (Radio Allergo Sorbent Test) laboratory. The advantage of this test is that the results are not influenced by drugs such as antihistamines and no risk for very sensitive patients.
Specific IgG-RAST examination
In addition to specific RAST IgE studies, specific RAST IgG screening should also be performed in autistic children with chronic food allergies for the slow type of allergy assessment. IgG that plays a role in allergic reactions is IgG with subtype G. Specific IgE and IgG-specific IgE examinations should be preceded by casein-free diet for 3 weeks, gluten-free for 3 months, free for (yeast) and phenol for 1-3 weeks.
Also read : Preventing Allergies In Infants Or Children
Feeding Food Allergies in Autistic Children
Countermeasures of food allergies are the most important elimination of food allergens from the diet of patients. These challenged foods should be determined by allergy tests for example by examining IgE RAST in the blood. Thus, foods that cause allergies are avoided by sufferers and there is no malnutrition. Specific IgE and IgG studies will result in four categories: high, medium, low and very low. Foods that should be avoided by sufferers are foods with low and medium categories. And based on specific IgE and IgG examinations, the patient performed a 4-day rotation diet by rotating food foods that have low and very low categories. Casein and gluten proteins derived from cow's milk and wheat should be avoided as enzymes to digest these proteins in autistic children are damaged and their digestive residues cause brain problems. Food additives such as synthetic dyes and MSG, and other chemicals (such as dehid formaldehyde, phenol, ethanol, ammonia, hydrocarbons, petrochemicals, cleaning liquids, paints, cigarettes, lube oil, perfume dye clothes synthetic, pesticides, plastic materials, basic materials for building construction, new carpets should be avoided, because these ingredients also affect patient behavior The recommended drink is distilled water.
Anti-allergic and anti-inflammatory drugs such as H1 and H2 receptor antihistamines, ketotyphenes, corticosteroids, and prostaglandin system inhibitors may be given but their use is controversial.
In the gastrointestinal tract that has a good barrier, defense food allergies are rare. Therefore, the prevention of food allergies can be frozen with breastfeeding as long as possible because breast milk contains IgA that blocks the removal of allergens from the intestinal lumen.
Various barrier defenses in the gastrointestinal tract will cause and aggravate the manifestation of food allergic diseases. Therefore, inflammatory Bowl Syndrome in children with autism, which can also cause a deficiency of nutrients, should be addressed. One way of handling is by providing antioxidants and vitamins and minerals.
Experts recommend treatment of Candida Albicans that can lead to hypersensitive reactions in the form of diet, supplementation of certain foods, and certain drugs. The recommended diet is a reduction of sugar intake, reduction of yeast and other foods that are considered to nourish the growth of Candida Albicans. Nystatin drugs, ketoconazole, and occasionally amphotericin B can be given at very low doses orally. Probiotics such as Lactobacillus Gg can be given to keep the intestinal flora in a balanced state.
Source: Holistic Management AUTISME, Indonesia's First National Autism Congress.
Information Center and Publishing Department of Internal Medicine FKUI, Matahati Special School Jakarta
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