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Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases.

Abstract

PURPOSE OF REVIEW

Although our general understanding of food hypersensitivity has improved in recent years, gastrointestinal food protein-induced diseases still pose diagnostic and therapeutic dilemmas.

RECENT FINDINGS

Food allergy in children and adults may involve any part of the gastrointestinal tract. Clinical presentations include protein-induced enterocolitis syndrome, enteropathy and proctocolitis, as well as eosinophilic gastroenteritis and related disorders. For many of these conditions, our understanding of the pathophysiology is incomplete. Manifestations are mostly non-IgE mediated, and skin prick testing and measurement of food-specific IgE antibody levels are of limited diagnostic value. Atopy patch testing may be of benefit in identifying food items associated with late-onset gastrointestinal reactions. A definitive diagnosis of gastrointestinal food allergy, however, still relies on formal food challenges. Depending on the clinical presentation, gastrointestinal biopsies may be required. In infancy, hypoallergenic formula or maternal elimination diets have been shown to effectively control the gastrointestinal manifestations of food allergies. Growth parameters and micronutrient levels need to be carefully monitored while on elimination diets for prolonged periods. In older children and adults with eosinophilic gastrointestinal disorders, the response to dietary restriction is variable. Corticosteroids may be required to control symptoms in those who failed to respond to hypoallergenic diets. In eosinophilic esophagitis, steroids can be administered topically in the form of swallowed aerosols. Leukotriene receptor antagonists and other novel therapies may be useful as steroid-sparing agents.

SUMMARY

Early diagnosis and treatment of food protein-induced gastrointestinal diseases may prevent significant nutritional complications. Further research is needed to develop diagnostic tools for these mainly cell-mediated disorders.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Allergy, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Victoria, Australia. ralf.heine@rch.org.au

    Source

    MeSH

    Digestive System
    Eosinophilia
    Esophagitis
    Food Hypersensitivity
    Gastric Mucosa
    Gastroenteritis
    Gastrointestinal Diseases
    Gastrointestinal Motility
    Humans
    Intestinal Mucosa
    Proctocolitis

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15126946

    Citation

    Heine, Ralf G.. "Pathophysiology, Diagnosis and Treatment of Food Protein-induced Gastrointestinal Diseases." Current Opinion in Allergy and Clinical Immunology, vol. 4, no. 3, 2004, pp. 221-9.
    Heine RG. Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases. Curr Opin Allergy Clin Immunol. 2004;4(3):221-9.
    Heine, R. G. (2004). Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases. Current Opinion in Allergy and Clinical Immunology, 4(3), pp. 221-9.
    Heine RG. Pathophysiology, Diagnosis and Treatment of Food Protein-induced Gastrointestinal Diseases. Curr Opin Allergy Clin Immunol. 2004;4(3):221-9. PubMed PMID: 15126946.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases. A1 - Heine,Ralf G, PY - 2004/5/6/pubmed PY - 2004/12/16/medline PY - 2004/5/6/entrez SP - 221 EP - 9 JF - Current opinion in allergy and clinical immunology JO - Curr Opin Allergy Clin Immunol VL - 4 IS - 3 N2 - PURPOSE OF REVIEW: Although our general understanding of food hypersensitivity has improved in recent years, gastrointestinal food protein-induced diseases still pose diagnostic and therapeutic dilemmas. RECENT FINDINGS: Food allergy in children and adults may involve any part of the gastrointestinal tract. Clinical presentations include protein-induced enterocolitis syndrome, enteropathy and proctocolitis, as well as eosinophilic gastroenteritis and related disorders. For many of these conditions, our understanding of the pathophysiology is incomplete. Manifestations are mostly non-IgE mediated, and skin prick testing and measurement of food-specific IgE antibody levels are of limited diagnostic value. Atopy patch testing may be of benefit in identifying food items associated with late-onset gastrointestinal reactions. A definitive diagnosis of gastrointestinal food allergy, however, still relies on formal food challenges. Depending on the clinical presentation, gastrointestinal biopsies may be required. In infancy, hypoallergenic formula or maternal elimination diets have been shown to effectively control the gastrointestinal manifestations of food allergies. Growth parameters and micronutrient levels need to be carefully monitored while on elimination diets for prolonged periods. In older children and adults with eosinophilic gastrointestinal disorders, the response to dietary restriction is variable. Corticosteroids may be required to control symptoms in those who failed to respond to hypoallergenic diets. In eosinophilic esophagitis, steroids can be administered topically in the form of swallowed aerosols. Leukotriene receptor antagonists and other novel therapies may be useful as steroid-sparing agents. SUMMARY: Early diagnosis and treatment of food protein-induced gastrointestinal diseases may prevent significant nutritional complications. Further research is needed to develop diagnostic tools for these mainly cell-mediated disorders. SN - 1528-4050 UR - https://www.unboundmedicine.com/medline/citation/15126946/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=15126946 DB - PRIME DP - Unbound Medicine ER -