Skip to main content

Advertisement

SpringerLink
Log in

Gastrointestinal food allergies: Do they exist?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Gastrointestinal (GI) symptoms are often attributed to adverse reactions to foods (ARF), but it is not always clear whether such reactions are caused by food allergy. A reaction to food proteins that is mediated by immunologic events is referred to as food allergy or food hypersensitivity. One of the most common types of food allergy is the IgE-mediated immediate hypersensitivity reaction to foods, which can give rise to dermatologic and respiratory tract symptoms in addition to GI complaints. Other GI forms of food allergy include food protein-induced enterocolitis or gastroenteropathy, celiac disease, and some cases of eosinophilic gastroenteritis. Because most patients complaining of adverse reactions to food have non-immune mechanisms for their complaints, it is important to distinguish the various types of ARF, as their management may differ substantially. Recent advances in the field of food allergy provide opportunities to improve diagnostic methods and develop new modalities for management that will complement the current practice of allergen avoidance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Metcalfe DD: Food allergies: clinical aspects. In Mucosal Immunology, edn 2. Edited by Ogra PL, Mestecky J, Lamm ME, et al. San Diego: Academic Press; 1999:1141–1151.

    Google Scholar 

  2. Sampson HA. Food allergy. Part 1: Immunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999, 103:717–728. See annotation for [3].

    Article  PubMed  CAS  Google Scholar 

  3. Sampson HA. Food allergy. Part 2: Diagnosis and management. J Allergy Clin Immunol 1999, 103:981–989. This two-part article by one of the leaders in food allergy provides a comprehensive and recent review of the topic. Over 200 references are cited, including many classic studies in the field. The clinical syndromes associated with food allergy are well reviewed in part 1, and a useful algorithm for the diagnostic evaluation is included in part 2.

    Article  PubMed  CAS  Google Scholar 

  4. Bischoff SC, Mayer JH, Manns MP: Allergy and the gut. Int Arch Allergy Immunol 2000, 121:270–283. This recent review of gastrointestinal food allergy includes a general overview of the field. The section on pathogenesis is very comprehensive, reflecting the first author’s expertise as one of the key investigators in pathogenetic mechanisms of gastrointestinal allergy.

    Article  PubMed  CAS  Google Scholar 

  5. Sampson HA, Sicherer SH, Birnbaum AH: AGA technical review on the evaluation of food allergy in gastrointestinal disorders. Gastroenterology 2001, 120:1026–1040. This very recent article accompanies the position statement of the American Gastroenterological Association on guidelines for the evaluation of food allergies [30]. A good summary of the various gastrointestinal presentations of food allergies is included, as well as a comprehensive discussion of the approaches available for diagnosis.

    Article  PubMed  CAS  Google Scholar 

  6. Sutton BJ, Gould HJ: The human IgE network. Nature 1993, 366:421–428.

    Article  PubMed  CAS  Google Scholar 

  7. Yocum MW, Butterfield JH, Klein JS, et al.: Epidemiology of anaphylaxis in Olmsted County: a population-based study. J Allergy Clin Immunol 1999, 104:452–456. This is the second study from Yocum et al. giving a retrospective review of the Olmsted County medical records to examine the epidemiology of anaphylaxis. As in other studies from industrialized nations including Great Britain, France, Italy, and Australia [16], food allergy was shown in this study to be the major cause of anaphylaxis.

    Article  PubMed  CAS  Google Scholar 

  8. Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA: Prevalence of peanut and tree nut allergy in the United States of America. J Allergy Clin Immunol 1999, 103:559–562.

    Article  PubMed  CAS  Google Scholar 

  9. Vander Leek TK, Liu AH, Stefanski K, et al.: The natural history of peanut allergy in young children and its association with serum peanut-specific IgE. J Pediatr 2000, 137:749–755. This study is the most recently published of a series of articles from various groups of investigators that examine peanut allergy. The article is notable for its presentation of evidence to challenge the current dogma that peanut sensitivity is retained for life. However, the results also indicate that the symptoms of the initial allergic reaction are not predictive of subsequent reactions, leading to a recommendation that all patients with peanut allergy need self-injectable epinephrine immediately available to treat potentially severe future reactions.

    Article  Google Scholar 

  10. Lessof MH, Wraith DG, Merrett TG, et al.: Food allergy and intolerance in 100 patients: local and systemic effects. QJM 1980, 195:259–271.

    Google Scholar 

  11. Burr ML: Food intolerance: a community survey. Br J Nutr 1983, 49:217–219.

    Article  PubMed  CAS  Google Scholar 

  12. Young E, Stoneham MD, Petruckevitch A, et al.: A population study of food intolerance. Lancet 1994, 343:1127–1130.

    Article  PubMed  CAS  Google Scholar 

  13. Sicherer SH, Sampson HA: Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999, 104:S114-S122.

    Article  PubMed  CAS  Google Scholar 

  14. Juntti H, Tikkanen S, Kokkonen J, et al.: Cow’s milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol 1999, 119:867–873.

    Article  PubMed  CAS  Google Scholar 

  15. Bock SA, Munoz-Furlong A, Sampson HA: Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001, 107:191–193. This is the most recent of a number of studies that have examined fatal reactions to food-induced anaphylaxis.

    Article  PubMed  CAS  Google Scholar 

  16. Boros CA, Kay D, Gold MS: Parent reported allergy and anaphylaxis in 4173 South Australian children. J Paediatr Child Health 2000, 36:36–40.

    Article  PubMed  CAS  Google Scholar 

  17. Sicherer SH: Determinants of systemic manifestations of food allergy. J Allergy Clin Immunol 2000, 106:S251-S257.

    Article  PubMed  CAS  Google Scholar 

  18. Berin MC, Kiliaan AJ, Yang PC, et al.: Rapid transepithelial antigen transport in rat jejunum: impact of sensitization and the hypersensitivity reaction. Gastroenterology 1997, 113:856–864.

    Article  PubMed  CAS  Google Scholar 

  19. Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. Gastroenterology 1992, 103:1075–1095.

    PubMed  CAS  Google Scholar 

  20. Crowe SE: Adverse gastroenterological reactions to food. Clin Perspect Gastroenterol 2000, 3:284–290.

    Google Scholar 

  21. Chung HL, Hwang JB, Kwon YD, et al.: Deposition of eosinophil-granule major basic protein and expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in the mucosa of the small intestine in infants with cow’s milk-sensitive enteropathy. J Allergy Clin Immunol 1999, 103:1195–1201.

    Article  PubMed  CAS  Google Scholar 

  22. Hogan SP, Mishra A, Brandt EB, et al.: A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy. Proc Natl Acad Sci U S A 2000, 97:6681–6686. See annotation for [24].

    Article  PubMed  CAS  Google Scholar 

  23. Mishra A, Hogan SP, Brandt EB, Rothenberg ME: An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001, 107:83–90. See annotation for [24].

    PubMed  CAS  Google Scholar 

  24. Hogan SP, Mishra A, Brandt EB, et al.: A pathological function for eotaxin and eosinophils in eosinophilic gastrointestinal inflammation. Nat Immunol 2001, 2:353–360. It is well established that mast cells and basophils are the key effector cells of allergic reactions. However, increasing evidence suggests that eosinophils also play a major role. These three articles provide experimental data demonstrating that eosinophils and their products are important in the pathogenesis of gastrointestinal food allergy.

    Article  PubMed  CAS  Google Scholar 

  25. Sicherer SH, Eigenmann PA, Sampson HA: Clinical features of food protein-induced enterocolitis syndrome. J Pediatr 1998, 133:214–219.

    Article  PubMed  CAS  Google Scholar 

  26. D’Netto MA, Herson VC, Hussain N, et al.: Allergic gastroenteropathy in preterm infants. J Pediatr 2000, 137:480–486.

    Article  PubMed  CAS  Google Scholar 

  27. Maki M, Collin P: Coeliac disease. Lancet 1997, 349:1755–1759.

    Article  PubMed  CAS  Google Scholar 

  28. Jarvinen KM, Laine ST, Jarvenpaa AL, Suomalainen HK: Does low IgA in human milk predispose the infant to development of cow’s milk allergy? Pediatr Res 2000, 48:457–462.

    Article  PubMed  CAS  Google Scholar 

  29. Hill DJ, Heine RG, Cameron DJ, et al.: Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis. J Pediatr 2000, 136:641–647.

    Article  PubMed  CAS  Google Scholar 

  30. American Gastroenterological Association: Position statement: guidelines for the evaluation of food allergies. Gastroenterology 2001, 120:1023–1025. This important document summarizes the information in [5]. It contains a series of tables and a flow chart that should be helpful for clinicians evaluating patients for possible food allergies.

    Article  Google Scholar 

  31. Sampson HA, Ho DG: Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997, 100:444–451.

    Article  PubMed  CAS  Google Scholar 

  32. Sampson HA, Broadbent KR, Bernhisel-Broadbent J: Spontaneous release of histamine from basophils and histaminereleasing factor in patients with atopic dermatitis and food hypersensitivity. N Engl J Med 1989, 321:228–232.

    Article  PubMed  CAS  Google Scholar 

  33. Reimann H-J, Lewin J: Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol 1988, 83:1212–1219.

    PubMed  CAS  Google Scholar 

  34. Bischoff SC, Mayer J, Wedemeyer J, et al.: Colonoscopic allergen provocation (COLAP): a new diagnostic approach for gastrointestinal food allergy. Gut 1997, 40:745–753.

    Article  PubMed  CAS  Google Scholar 

  35. Kokkonen J: Lymphonodular hyperplasia on the duodenal bulb indicates food allergy in children. Endoscopy 1999, 31:464–467.

    Article  PubMed  CAS  Google Scholar 

  36. Sampson HA, Mendelson L, Rosen JP: Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992, 327:380–384.

    Article  PubMed  CAS  Google Scholar 

  37. Heyman M. Evaluation of the impact of food technology on the allergenicity of cow’s milk proteins. Proc Nutr Soc 1999, 58:587–592.

    PubMed  CAS  Google Scholar 

  38. Burks AW, King N, Bannon GA: Modification of a major peanut allergen leads to loss of IgE binding. Int Arch Allergy Immunol 1999, 118:313–314.

    Article  PubMed  CAS  Google Scholar 

  39. Rabjohn P, Helm EM, Stanley JS, et al.: Molecular cloning and epitope analysis of the peanut allergen Ara h 3. J Clin Invest 1999, 103:535–542.

    Article  PubMed  CAS  Google Scholar 

  40. MacGlashan DW, Bochner BS, Adelman DC, et al.: Down-regulation of Fc(epsilon)RI expression on human basophils during in vivo treatment of atopic patients with anti-IgE antibody. J Immunol 1997, 158:1438–1445.

    PubMed  CAS  Google Scholar 

  41. Roy K, Mao HQ, Huang SK, Leong KW: Oral gene delivery with chitosan DNA nanoparticles generates immunologic protection in a murine model of peanut allergy. Nat Med 1999, 5:387–391. This is the first study to report successful oral DNA vaccination in the quest to modulate gut allergic responses to food. Further studies are needed in animal models with the hope that such approaches may be applied to human food allergy in the future.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, 22908-0708, Charlottesville, VA, USA

    Sheila E. Crowe MD,FRCPC

Authors
  1. Sheila E. Crowe MD,FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crowe, S.E. Gastrointestinal food allergies: Do they exist?. Curr Gastroenterol Rep 3, 351–357 (2001). https://doi.org/10.1007/s11894-001-0059-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-001-0059-7

Keywords

Search

Navigation