Current Gastroenterology Reports

, Volume 3, Issue 4, pp 351–357

Gastrointestinal food allergies: Do they exist?

  • Sheila E. Crowe
Article

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.

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References and Recommended Reading

  1. 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. 2.
    Sampson HA. Food allergy. Part 1: Immunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999, 103:717–728. See annotation for [3].PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Sutton BJ, Gould HJ: The human IgE network. Nature 1993, 366:421–428.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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. 11.
    Burr ML: Food intolerance: a community survey. Br J Nutr 1983, 49:217–219.PubMedCrossRefGoogle Scholar
  12. 12.
    Young E, Stoneham MD, Petruckevitch A, et al.: A population study of food intolerance. Lancet 1994, 343:1127–1130.PubMedCrossRefGoogle Scholar
  13. 13.
    Sicherer SH, Sampson HA: Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999, 104:S114-S122.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Sicherer SH: Determinants of systemic manifestations of food allergy. J Allergy Clin Immunol 2000, 106:S251-S257.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. Gastroenterology 1992, 103:1075–1095.PubMedGoogle Scholar
  20. 20.
    Crowe SE: Adverse gastroenterological reactions to food. Clin Perspect Gastroenterol 2000, 3:284–290.Google Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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].PubMedCrossRefGoogle Scholar
  23. 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].PubMedGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Sicherer SH, Eigenmann PA, Sampson HA: Clinical features of food protein-induced enterocolitis syndrome. J Pediatr 1998, 133:214–219.PubMedCrossRefGoogle Scholar
  26. 26.
    D’Netto MA, Herson VC, Hussain N, et al.: Allergic gastroenteropathy in preterm infants. J Pediatr 2000, 137:480–486.PubMedCrossRefGoogle Scholar
  27. 27.
    Maki M, Collin P: Coeliac disease. Lancet 1997, 349:1755–1759.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 33.
    Reimann H-J, Lewin J: Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol 1988, 83:1212–1219.PubMedGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 35.
    Kokkonen J: Lymphonodular hyperplasia on the duodenal bulb indicates food allergy in children. Endoscopy 1999, 31:464–467.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2001

Authors and Affiliations

  • Sheila E. Crowe
    • 1
  1. 1.Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleUSA

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