Update Reference: Allergy, Intolerance and Gatrointestinal Disease

Adverse reactions to food that result in gastrointestinal symptoms are common in the general population; while only a minority of such individuals will have symptoms due to immunologic reactions to foods, gastrointestinal food allergies do exist in both children and adults. Gastrointestinal food allergies may be defined as clinical syndromes which are characterised by the onset of gastrointestinal symptoms following food ingestion where the underlying mechanism is an immunologically mediated reaction within the gastrointestinal tract.

The ingestion of food is frequently associated with specific adverse gastrointestinal symptoms, including emesis, diarrhea, abdominal cramping, and gastrointestinal bleeding. This brief review discusses a variety of food-induced gastrointestinal diseases and will highlight the recent information pertaining to the pathophysiology, clinical presentation, diagnostic approach, and treatment of these disorders. Reactions resulting from immediate hypersensitivity and cell-mediated processes will be reviewed in detail, as well as other proposed pathophysiologic mechanisms. The clinical presentation and diagnostic approach to several food-induced gastrointestinal diseases will be individually examined.

These immune reactions are mediated by immunoglobulin E-dependent and -independent mechanisms involving mast cells, eosinophils, and other immune cells, but the complexity of the underlying mechanisms of pathogenesis have yet to be fully defined. Knowledge of the spectrum of adverse reactions to foods that affect the digestive system, including gastrointestinal food allergy, is essential to correctly diagnose and manage the subset of patients with immunologically mediated adverse reactions to foods. Potentially fatal reactions to food necessitate careful instruction and monitoring on the part of health care workers involved in the care of individuals at risk of anaphylaxis. New methods of diagnosis and novel strategies for treatment, including immunologic modulation and the development of hypoallergenic foods, are exciting developments in the field of food allergy.

These gastrointestinal symptoms, principally vomiting and diarrhoea, sometimes abdominal colic, may be accompanied by other symptoms outside the alimentary tract. The clinical spectrum of these disorders ranges from acute anaphylaxis (rarely leading to death in infancy) to relatively minor symptoms which are difficult to distinguish from other disorders such as toddler’s diarrhoea or psychologic disorders. The same food, e.g. cow’s milk, may produce a wide range of clinical manifestations. In the one individual, clinical features may change with age. The incidence of gastrointestinal food allergic disease is greatest in the first year of life and decreases with age. There are, broadly speaking, two categories of clinical syndromes which are related to speed of onset of symptoms: immediate and delayed. Those syndromes which manifest immediately after food ingestion are usually easy to diagnose and specific IgE tests and skin prick tests are frequently positive. Those which have a delayed onset of up to several days are difficult to diagnose, and currently available investigations may be unsatisfactory for routine use.

In current clinical practice, gastrointestinal syndromes which can be manifestations of food allergy, may be grouped as follows:

  • immediate syndromes, including anaphylaxis and acute vomiting +/- diarrhoea in association with cutaneous and respiratory manifestations; and
  • delayed syndromes, including food-sensitive small intestinal enteropathies, food-sensitive colitis, multiple food allergy +/- enteropathy, and infantile colic

Update Reference: Allergy, Intolerance and Gatrointestinal  Disease

      
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