Gastrointestinal Manifestations of Food Allergy

Shereen M. Reda

Disclosures

Pediatr Health. 2009;3(3):217-229. 

In This Article

Abstract and Introduction

Abstract

Gastrointestinal food allergies are not rare in infants and children. Symptoms include vomiting, reflux, abdominal pains, diarrhea and constipation. Clinical diagnosis requires the exclusion of nonimmunologic diseases that have similar gastrointestinal symptoms. In food allergy, the immune reactions involved can be immunoglobulin (Ig)E-mediated, cell-mediated or both. Symptoms in other target organs are common in cases of IgE-mediated disorders, but not in the cell-mediated disorders in which symptoms are usually localized to the gut. Diagnosis utilizes detailed medical history, clinical evaluation, skin testing, food-specific IgE antibodies, responses to elimination diet and oral food challenges. Endoscopic biopsies are essential in cell-mediated disorders and allergic eosinophilic gastropathies. Treatment includes avoidance of the offending food by a restriction diet in children and the use of hydrolyzed or amino acid-based formulas in young infants. Topical and/or systemic corticosteroids can also be used in eosinophilic esophagitis. Current research is aimed at improving the diagnostic tools and therapeutic options available to patients.

Introduction

Infants and children often present to clinicians with food-related gastrointestinal (GI) problems that are commonly perceived by the parents to be a food allergy. However, not every case is a true food allergy. There are several nonallergic conditions[1] that have similar GI symptoms to those of food allergies and, thus, nonallergic conditions should be excluded before a definite diagnosis of food allergy is established (Box 1).

Food allergy is an adverse immune response to food protein(s)[2] and affects as many as 6-8% of children below 3 years of age and approximately 4% of adults in the USA.[3] Any food can cause allergy, however, the most common foods that produce allergy in infant and children are cow's milk, hen's egg, soybeans, wheat, peanut, tree nuts, fish and shellfish. In GI food allergies, the underlying immune responses may be IgE-mediated, cell-mediated or both (Box 2). Unlike the acute manifestations seen in IgE-mediated food hypersensitivity, cell-mediated reactions have relatively subacute or chronic symptoms that are difficult to discriminate from gastroenteritis.[2,3,4,5] Delayed diagnosis may result in significant growth retardation, anemia and severe malnutrition in the worst cases.[6]

This review will focus on the current knowledge of various GI food allergic disorders in terms of clinical picture, methods of diagnosis, and treatment.

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