Gastrointestinal food allergies: Do they exist?
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.
Unable to display preview. Download preview PDF.
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
- 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.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.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 . 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
- 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 , food allergy was shown in this study to be the major cause of anaphylaxis.PubMedCrossRefGoogle 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.CrossRefGoogle 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
- 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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 . It contains a series of tables and a flow chart that should be helpful for clinicians evaluating patients for possible food allergies.CrossRefGoogle 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.PubMedCrossRefGoogle Scholar