Metaanalisis Peranan Teknologi Proses Pengolahan terhadap Penurunan Alergenisitas Ikan

Abstract

Pada tahun 2017 Food and Drugs Administration (FDA) mengkategorikan ikan ke dalam salah satu dari delapan jenis bahan pangan yang umumnya menyebabkan reaksi alergi pada individu sensitif. Manifestasi klinis yang disebabkan alergi ikan bervariasi mulai dari gejala ringan hingga berat, bahkan sampai mengancam jiwa. Produk ikan hipoalergenik merupakan salah satu alternatif pangan bagi penderita alergi ikan. Produk hipoalergenik dapat dihasilkan antara lain dengan penerapan teknologi proses pengolahan pada proses produksinya. Pemahaman yang lebih lengkap mengenai perubahan alergenisitas ikan setelah diberikan perlakuan proses pengolahan perlu dipelajari lebih lanjut sehingga dapat diketahui teknologi proses pengolahan yang efektif dalam menurunkan alergenisitas ikan. Metaanalisis digunakan untuk mendapatkan bukti ilmiah berdasarkan hasil analisis statistik terhadap data-data ilmiah yang dihasilkan dari berbagai hasil penelitian di laboratorium yang telah dipublikasi dalam jurnal ilmiah. Penelitian ini bertujuan: (1) untuk menentukan teknologi proses pengolahan yang efektif dalam menurunkan alergenisitas ikan; serta (2) memperoleh data perubahan alergenisitas ikan pada tingkat seluler melalui kajian metaanalisis. Metaanalisis dilakukan dalam enam tahapan, yaitu: (1) perumusan pertanyaan penelitian; (2) penentuan kriteria inklusi dan eksklusi; (3) penyusunan strategi pencarian data; (4) seleksi artikel jurnal dari berbagai pangkalan data; (5) ekstraksi data berdasarkan kriteria yang telah ditentukan; serta (6) pengolahan dan interpretasi data. Data dianalisis menggunakan perangkat lunak Revman dengan ukuran efek standardized mean difference (SMD). Nilai SMD [95% CI] lebih dari 0,8 dan tidak melewati titik 0,00 menunjukkan bahwa teknologi proses pengolahan efektif dalam menurunkan alergenisitas ikan. Data yang diekstrak berupa nilai IgE, pelepasan sitokin (IL-4 dan IL-13) dan mediator inflamasi (triptase, histamin, dan -heksosaminidase). Delapan pangkalan data digunakan dalam penelitian ini, yaitu ACS, EBSCO, Google Schoolar, ProQuest, PubMed, ScienceDirect, Taylor & Francis, dan Wiley Online Library. Sebanyak 5588 artikel jurnal berhasil terkumpul yang kemudian diseleksi berdasarkan tahapan preferred reporting items for systematic reviews and meta-analysis (PRISMA). Khusus nilai IgE dilakukan analisis subgrup dengan mengelompokkan teknologi proses pengolahan menjadi empat kelompok, yaitu proses pengolahan dengan panas (perebusan, pengukusan, penggorengan, dan pemanggangan); proses pemanasan langsung; high hydrostatic pressure (HHP); dan reaksi Maillard. Diperoleh 12 artikel jurnal sesuai dengan kriteria yang telah ditentukan dari 5588 artikel jurnal yang berhasil diidentifikasi. Kedua belas artikel jurnal terpilih kemudian diekstrak dan didapatkan 150 data pengaruh teknologi proses pengolahan terhadap alergenisitas ikan. Berdasarkan nilai SMD [95% CI], tiga dari empat subgrup berpengaruh signifikan dalam menurunkan alergenisitas ikan, yaitu proses pemanasan langsung, HHP, dan reaksi Maillard. Nilai SMD [95% CI] untuk proses pengolahan panas = 0.15 [-0,37 s.d. 0.66]; pemanasan langsung = -1,03 [-1,76 s.d. -0,30]; HHP = -3,28 [-4,93 s.d. -1,64]; dan reaksi Maillard = -1,36 [-2,45 s.d. -0,27]. SMD bernilai negatif menunjukkan adanya penurunan alergenisitas, sedangkan peningkatan alergenisitas ditandai dengan SMD yang bernilai positif. Pada tingkat seluler, teknologi proses pengolahan dapat menurunkan alergenisitas secara signifikan yang ditunjukkan dengan terjadinya penurunan pelepasan sitokin (IL-4 dan IL-13) dan mediator inflamasi (triptase, histamin, dan -heksosaminidase). Nilai SMD [95% CI] untuk IL-4 = -3,05 [-4,57 s.d. -1,53]; IL-13 = -3,76 [-5,22 s.d. -2,09]; triptase = -3,88 [-5,78 s.d. -1,97]; histamin = -2,94 [-4,26 s.d. -1,16]; dan -hexosamidase = -2,84 [-4,16 s.d. -1,53]. Hasil penelitian menunjukkan bahwa HHP mampu menurunkan alergenisitas ikan. Proses pengolahan ikan yang efektif dalam menurunkan alergenisitas ikan adalah HHP dengan nilai SMD [95% CI] sebesar -3,28 [-4,93 s.d. -1,64]. Pada tingkat seluler, teknologi proses pengolahan ikan yang melibatkan reaksi enzimatis dan penambahan antioksidan berpengaruh signifikan dalam menurunkan pelepasan sitokin dan mediator inflamasi.

In 2017 The Food and Agriculture Organization (FAO) categorizes fish into one of eight types of food ingredients that generally cause allergic reaction in sensitive individuals. Clinical manifestations caused by fish allergy vary from mild to severe symptoms, even life-threatening. Hypoallergenic fish product is alternative food for people with fish allergy. Hypoallergenic product can be produced by applying processing technology in the production process. To obtained the most effective processing technology in reducing fish allergenicity, a complete understanding of changes in fish allergenicity after processing needs to be studied further. Meta-analysis approach is used to obtain scientific evidence based on the results of statistical analysis of scientific data generated from various laboratory research that have been published in scientific journals. This study aims to: (1) determine the most effective processing technology in reducing fish allergenicity; and (2) to obtain data on fish allergenicity alteration on cellular level through meta-analysis. Meta-analysis was carried out in six steps, namely; (1) formulating questions; (2) determining inclusion and exclusion criteria; (3) determining search protocol; (4) assessing quality of the literature from several databases; (5) extracting data based on criteria; and (6) processing and interpreting data. Data were analyzed using Revman with Standardized Mean Difference (SMD) effect size. SMD [95% CI] value more than 0.8 and does not exceed 0.00 proving the effectiveness of the processing technology in reducing fish allergenicity. The extracted data were based on IgE value, release of cytokines (IL-4 and IL-13), and inflammatory mediators (tryptase, histamine, and -hexosaminidase). Eight databases were used in this study, namely ACS, EBSCO, Google Schoolar, ProQuest, PubMed, ScienceDirect, Taylor & Francis, and Wiley Online Library. A total of 5588 articles were collected and then selected based on preferred reporting items for systematic reviews and meta-analysis (PRISMA). For IgE, subgroup analysis was carried out by grouping the processing technology into four groups, namely heat treatment process, direct heating, high hydrostatic pressure (HHP), and Maillard reaction. In total 12 articles were obtained according to predetermined criteria from 5588 identified journal articles. Then the twelves selected journal articles were extracted and successfully obtained 150 data on the effect of processing technology on fish allergenicity. Based on SMD [95% CI], three-of-four methods had significant effect on reducing fish allergenicity, namely direct heating, HHP, and Maillard reaction. SMD [95% CI] value for heat treatment process = 0.15 [-0.37 to 0.66]; direct heating = -1.03 [-1.76 to -0.30]; HHP = -3.28 [-4.93 to -1.64]; and Maillard reaction = -1.36 [-2.45 to -0.27]. A negative SMD indicates a decrease in allergenicity, while an increase in allergenicity is indicated by a positive SMD. At cellular level, processing technology significantly reduce allergenicity as indicated by the release of cytokines (IL-4 and IL-13) and inflammatory mediators (tryptase, histamine, and -hexosamindase). SMD [95% CI] value for IL-4 = -3.05 [-4.57 to -1.53]; IL-13 = -3.76 [-5.22 to -2.09]; tryptase = -3.88 [-5.78 to -1.97]; histamine = -2.94 [-4.26 to -1.16]; and beta-hexosamidase = -2.84 [-4.16 to -1.53]. The results showed that the application processing technology was able to reduce the allergenicity of fish. The most effective processing technology in reducing fish allergenicity is HHP with SMD value [95% CI] -3.28 [-4.93 to -1.64]. On cellular level, fish processing technology involving enzymatic reactions and the addition of antioxidants has a significant effect on reducing the release of cytokines and inflammatory mediators.