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Food Allergies, Food Intolerances, and Carbohydrate Malabsorption

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Essential Medical Disorders of the Stomach and Small Intestine

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Abstract

Up to 20% of the general population and more than half of the patients with irritable bowel syndrome report recurrent adverse reactions to specific food(s) or food group(s). Most of these reactions are not driven by the immune system and they are known as food intolerances. These nonimmunological adverse food reactions can result from a variety of disorders, including gastroesophageal reflux disease (GERD), metabolic diseases, toxin-mediated reactions, gastrointestinal infections, deficiency of digestive enzymes, and disorders resulting from many anatomic and neurologic abnormalities. In contrast, food allergy is an abnormal immunological reaction to food. It is broadly categorized into immunoglobulin E (IgE)-mediated, non-IgE-mediated, and mixed IgE/non-IgE-mediated. In this chapter, a case study of wheat-related disorders is presented in order to demonstrate the key differences between food allergy and intolerance and to discuss the approach to their diagnosis and treatment.

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References

  1. Lomer MCE. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther. 2015;41(3):262–75.

    Article  CAS  Google Scholar 

  2. Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108(5):634–41.

    Article  Google Scholar 

  3. Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther. 2015;41(1):3–25.

    Article  CAS  Google Scholar 

  4. Sampson HA. Differential diagnosis in adverse reactions to foods. J Allergy Clin Immunol. 1986;78(1):212–9.

    Article  CAS  Google Scholar 

  5. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 0):S1–58.

    Google Scholar 

  6. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41–58.

    Article  CAS  Google Scholar 

  7. Valenta R, Hochwallner H, Linhart B, Pahr S. Food allergies: the basics. Gastroenterology. 2015;148(6):1120–1131.e4.

    Article  CAS  Google Scholar 

  8. Leung J, Beukema KR, Shen AH. Allergic mechanisms of eosinophilic oesophagitis. Best Pract Res Clin Gastroenterol. 2015;29(5):709–20.

    Article  CAS  Google Scholar 

  9. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol: WJG. 2014;20(22):6759–73.

    Article  Google Scholar 

  10. Fedewa A, Rao SSC. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep. 2014;16(1):370.

    Article  Google Scholar 

  11. Raithel M, Weidenhiller M, Hagel AF-K, Hetterich U, Neurath MF, Konturek PC. The malabsorption of commonly occurring mono and disaccharides. Dtsch Ärztebl Int. 2013;110(46):775–82.

    PubMed  PubMed Central  Google Scholar 

  12. Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, et al. Celiac disease: from pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017;8(2):27–38.

    Article  Google Scholar 

  13. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679–92; quiz 693.

    Article  Google Scholar 

  14. Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology. 2018;154(3):529–539.e2.

    Article  CAS  Google Scholar 

  15. Moshfegh AJ, Friday JE, Goldman JP, Ahuja JK. Presence of inulin and oligofructose in the diets of Americans. J Nutr. 1999;129(7 Suppl):1407S–11S.

    Article  CAS  Google Scholar 

  16. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112(5):775–84.

    Article  CAS  Google Scholar 

  17. Marinkovich V. Specific IgG antibodies as markers of adverse reactions to foods. Monogr Allergy. 1996;32:221–5.

    CAS  PubMed  Google Scholar 

  18. Bock SA. AAAAI support of the EAACI position paper on IgG4. J Allergy Clin Immunol. 2010;125(6):1410.

    Article  Google Scholar 

  19. Hammond C, Lieberman JA. Unproven diagnostic tests for food allergy. Immunol Allergy Clin North Am. 2018;38(1):153–63.

    Google Scholar 

  20. Crowe SE, Leung J. Food allergy and food intolerance. In: Mullin GE, Matarese LE, Palmer M, editors. Gastrointestinal and liver disease nutrition desk reference. Boca Raton: CRC Press; 2011. p. 72–4.

    Google Scholar 

  21. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327(6):380–4.

    Article  CAS  Google Scholar 

  22. Food Allergy & Anaphylaxis Emergency Care Plan|Food Allergy Research & Education [Internet]. [cited 2018 Jul 19]. Available from: https://www.foodallergy.org/life-with-food-allergies/food-allergy-anaphylaxis-emergency-care-plan

  23. Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. 2001;108(6):881–90.

    Article  CAS  Google Scholar 

  24. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67–75.e5.

    Article  CAS  Google Scholar 

  25. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252–8.

    Article  Google Scholar 

Essential Reading

  • Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41–58. This review article comprises of recent updates in the understanding of food allergy.

    Google Scholar 

  • Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, et al. Fructan, rather than gluten, induces symptoms in patients with selfreported non-celiac gluten sensitivity. Gastroenterology. 2018;154(3):529–539.e2. This paper shares the details of the first randomized, placebo-controlled trial to demonstrate that patients with NCGS actually appear to be intolerant to fructan, not gluten.

    Google Scholar 

  • Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67–75. e5. This article reports the results of the first multicenter, randomized, controlled, single-blind trial to show the efficacy of low FODMAP diet in the treatment IBS.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Food Related Diseases at Tufts Medical Center, Boston, MA, USA

    John Leung

  2. Food Allergy Center at Floating Hospital of Tufts Medical Center, Boston, MA, USA

    John Leung

  3. Department of Gastroenterology and Department of Pediatric Allergy and Immunology, Tufts Medical Center, Boston, MA, USA

    John Leung

  4. Department of Gastroenterology, Tufts Medical Center, Boston, MA, USA

    Apaar Dadlani

  5. Division of Gastroenterology, Department of Medicine, University of California in San Diego, La Jolla, CA, USA

    Sheila Eileen Crowe

Authors
  1. John Leung
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  2. Apaar Dadlani
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  3. Sheila Eileen Crowe
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Corresponding author

Correspondence to Sheila Eileen Crowe .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1. Which one of the following disorders is classified as food allergy?

    1. A.

      Eosinophilic esophagitis

    2. B.

      Pancreatitis

    3. C.

      Irritable bowel syndrome

    4. D.

      Fructan intolerance

  • Question 2. A 20-year-old female comes to the office complaining of 3-year history of altered bowel movements, vomiting, and abdominal pain relieved with defecation and often associated with consumption of fruit juices, soda, honey, and maple syrup. Which one of the following will not be helpful in determining the diagnosis?

    1. A.

      History and physical examination

    2. B.

      Presence of serum IgG4 antibodies

    3. C.

      Fructose hydrogen and methane breath test

    4. D.

      Small intestinal bacterial overgrowth breath test

  • Question 3. Which one of the following is not a part of the “four-E” approach indicated in the management of IgE-mediated food allergy?

    1. A.

      Exposure of allergen later in life leads to development of tolerance

    2. B.

      Elimination of known allergen from all possible dietary sources

    3. C.

      Education about the allergen, its sources, symptoms caused in case of reaction, and management of the reaction

    4. D.

      Early recognition of symptoms of allergic reaction

    5. E.

      Epinephrine administration when indicated

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Leung, J., Dadlani, A., Crowe, S.E. (2019). Food Allergies, Food Intolerances, and Carbohydrate Malabsorption. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_21

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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