Gastrointestinal Food Allergies

Abstract

Gastrointestinal food allergies present during early childhood with a diverse range of symptoms. Cow's milk, soy and wheat are the three most common gastrointestinal food allergens. Several clinical syndromes have been described, including food protein-induced enteropathy, proctocolitis and enterocolitis. In contrast with immediate, IgE-mediated food allergies, the onset of gastrointestinal symptoms is delayed for at least 1-2 hours after ingestion in non-IgE-mediated allergic disorders. The pathophysiology of these non-IgE-mediated allergic disorders is poorly understood, and useful in vitro markers are lacking. The results of the skin prick test or measurement of the food-specific serum IgE level is generally negative, although low-positive results may occur. Diagnosis therefore relies on the recognition of a particular clinical phenotype as well as the demonstration of clear clinical improvement after food allergen elimination and the reemergence of symptoms upon challenge. There is a significant clinical overlap between non-IgE-mediated food allergy and several common paediatric gastroenterological conditions, which may lead to diagnostic confusion. The treatment of gastrointestinal food allergies requires the strict elimination of offending food allergens until tolerance has developed. In breast-fed infants, a maternal elimination diet is often sufficient to control symptoms. In formula-fed infants, treatment usually involves the use an extensively hydrolysed or amino acid-based formula. Apart from the use of hypoallergenic formulae, the solid diets of these children also need to be kept free of specific food allergens, as clinically indicated. The nutritional progress of infants and young children should be carefully monitored, and they should undergo ongoing, regular food protein elimination reassessments by cautious food challenges to monitor for possible tolerance development.

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

“…Nevertheless, from the published data, it is thought that children with food protein–induced enteropathy present with gastrointestinal symptoms in early infancy. Data on cow's milk– and soya‐related enteropathy indicate presentation within the first 2 years of life, and although current data indicate that the majority outgrow this allergy by 24‐36 months of age, a study from Kokkonen et al does indicate that this non‐IgE‐mediated allergy may persist into the early school years.…”

“…Using the European Academy for Allergy and Clinical Immunology (EAACI) nomenclature, this allergic disorder encompasses different gastrointestinal allergies varying in presentation and includes food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy, allergic dysmotility disorders [gastro-oesophageal reflux disorder (GORD) and constipation], eosinophilic gastrointestinal disorders (EGID), including eosinophilic oesophagitis (EoE) and non-IgE-mediated AD (Figure 1). [15][16][17][18] According to the nomenclature of the National Institute for Allergy and Infectious Disease, EoE is classified as a mixed IgE and non-IgEmediated allergy; however, this was published prior to the recent article by Simon et al, 19 proposing EoE as a non-IgE-mediated allergic condition. For the purpose of this publication, EoE will be therefore discussed as a non-IgE-mediated condition, as per EAACI nomenclature.…”

Non‐IgE‐mediated gastrointestinal food allergies in children

“…Faulty feeding techniques (i.e., underfeeding, overfeeding, and/or swallowing air) may also contribute to colic development (135). Food allergens may be relevant in a subset of patients with severe colic (132) and those with atopic dermatitis. Systematic reviews confirmed the benefit of hypoallergenic hydrolyzed or soy formula as well as low-allergenic maternal diet in exclusively breastfed colicky infants (17,18,20,132,(136)(137)(138)(139)(140)(141)(142)(143).…”

“…Food allergens may be relevant in a subset of patients with severe colic (132) and those with atopic dermatitis. Systematic reviews confirmed the benefit of hypoallergenic hydrolyzed or soy formula as well as low-allergenic maternal diet in exclusively breastfed colicky infants (17,18,20,132,(136)(137)(138)(139)(140)(141)(142)(143). However, these studies have methodological limitations and the fact that colic is a transient disorder resolving within few weeks, renders investigations of the effect of restrictive diet particularly difficult (144).…”

“…The role of CM in constipation is controversial (174). Transition from breast milk to CM-formula is often associated with mild constipation, and CM-formula has been associated with greater stool hardness (132,175). Beneficial effect of CM-free diet was found in 28% to 78% of children with chronic constipation in prospective clinical trials (8,9,(176)(177)(178)(179)(180)(181)(182)(183)(184).…”