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In this review I have described the pathophysiology of allergic disorders of the gastrointestinal tract. Situations where the intestine cannot be a complete barrier to foreign allergens and antigens were discussed and etiological factors of gastrointestinal allergy were detailed. Clinical features of gastrointestinal allergy include diarrhea, vomiting, abdominal pain and colic, intestinal hemorrhage and malabsorption as well as symptoms and signs outside the gastrointestinal tract such as chronic rhinitis and asthma in the respiratory system, urticaria, angioedema and eczema as dermatological signs, headache, insomnia, hyperkinesis as central nervous system manifestations, failure to thrive and anaphylaxis as constitutional reactions. Milk allergy was discussed as an example of food allergy. Immunology of the gastrointestinal tract was presented, with examples of four types of hypersensitivity reactions, and gastrointestinal disturbances of immunodeficiency disorders and syndromes were named. Lastly, the autoimmune mechanism and the gut were described, with particular discussion of ulcerative colitis as an example of an autoimmune disease.
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PMID:The intestine in allergic diseases. 78 84

We have studied 50 children suspected to have food allergy. Their clinical diagnoses included the following: digestive trouble (prolonged diarrhoea or vomiting), abdominal pain, repetitive urticaria, angioneurotic edema, eczema. The aim of thie study has been to value the results obtained with the hemagglutination test according to Boyden, comparing them with skin tests carried out through intradermal techniques. 113 hemagglutination and skin tests with varying foods have been carried out. Nearly all the children have been tested with milk, white and yolk of egg, the most suspected foods, and also other foods depending on the data found through anamnesis. With milk (47 cases) we have obtained positivity in 12 hemagglutination tests, and in 3 skin tests. With egg (41 cases) the hemagglutination test has been positive in 14 cases, and the skin test in 5 cases. Conjunctly in the 113 cases we have obtained positive hemagglutination test in 44 cases, and positive skin test in 14 cases. In 65 cases both tests have been negative. This fact points to the necessity to realize other diagnostic tests, as well the possibility that these children have no allergic disease. Summarizing, these results support the superior value of the hemagglutination Boyden test in comparison with the skin test as diagnosic proof in food allergy.
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PMID:[Hemagglutination test and the diagnosis of food allergy]. 124 48

A total of 105 "high-risk" infants born in 1988 were studied prospectively from birth to 18 months of age. The infants were recommended breastfeeding and/or hypoallergenic formula (Nutramigen or Profylac) combined with avoidance of solid foods during the first 6 months of life. All mothers had unrestricted diet. Avoidance of daily exposure to tobacco smoke, furred pets and dust-collecting materials in the bedroom were advised. This prevention group was compared with a control group consisting of 54 identically defined "high-risk" infants born in 1985 in the same area. All infants had either severe single atopic predisposition combined with cord blood IgE > or = 0.5 KU/l or biparental atopic predisposition. The control group had unrestricted diet and was not advised about environmental factors. Apart from the prevention programme and year of birth the prevention group and the control group were comparable. The parents were highly motivated and compliance was good. The rate of participation was 97%, and 85% followed the dietary measures strictly. The cumulative prevalence of atopic symptoms was significantly lower at 18 months in the prevention group (32%), as compared with the control group (74%) (p < 0.01), due to reduced prevalence of recurrent wheezing (13% versus 37%; p < 0.01), atopic dermatitis (14% versus 31%; p < 0.01), vomiting/diarrhoea (5% versus 20%; p < 0.01) and infantile colic (9% versus 24%; p < 0.01). The cumulative prevalence of food allergy was significantly lower in the prevention group (6% versus 17%; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. A prospective study of 159 "high-risk" infants. 148 60

Gastrointestinal symptoms occur in a large number of patients with food allergies. Immediate hypersensitivity mechanisms may give rise to the nausea, vomiting, abdominal pain, and diarrhea experienced by these patients. However, there are limited human data about the pathophysiological basis for these symptoms. Most of the available information comes from a variety of animal models. This article reviews the literature using models of intestinal food hypersensitivity, as well as human studies, that have contributed to our understanding of the pathophysiological mechanisms in gastrointestinal food hypersensitivity.
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PMID:Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. 149 10

A total of 65 patients with food allergy which manifested primarily by disorders of the gastrointestinal tract, bronchi and skin were placed under observation. The patients were administered sodium chromoglycate (nalcrom) per os in a dose of 200 mg 4 times a day for 2-3 weeks, in part of cases up to 3 months and even up to 1-1.5 year. The skin manifestations of allergy (pruritus, urticaria, Quincke's edema, and eczematous rash), abdominal pain, diarrhea, vomiting, bronchospasm, rhinitis, and conjunctivitis disappeared. At the same time the majority of the patients demonstrated the reduction of the intensity of skin responses to the administration of different food antigens, the decrease of the antibody titer in blood serum in response to food antigens, and of the IgE content in blood. The side effects (nausea, heartburn, intensification of skin itch and abdominal pain) were noted in 4 cases.
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PMID:[Treatment of patients with food allergy using Nalcrom]. 249 73

Food allergy in childhood presents with different clinical manifestations depending on the age of the affected child. Whereas toddlers and children with food allergy or pseudo-allergy present with similar symptoms as adults, two different forms have been identified in the newborn and infant period. One can occur as allergic colitis in breast or bottle fed infants. In breast fed infants the bloody mucoid stools are produced because of an allergic reaction of the colonic mucosa to foreign proteins which are delivered to the baby via breast milk. In bottle fed infants the given foreign protein itself can trigger the allergic reaction. The clinical, endoscopical and histological appearance is similar to that of ulcerative colitis. Elimination of foreign proteins from the diet of the mother or in bottle fed infants from the child is the therapy of choice. The second manifestation of food allergy in this age group is the cow's milk protein intolerance with predominantly gastrointestinal symptoms such as vomiting, diarrhea and failure to thrive. The diagnosis is based on the clinical picture alone. The usual laboratory tests don't discriminate enough and can therefore not confirm the diagnosis. Elimination of the affecting protein and replacement by a semi-elementary diet are recommended for therapy. The prevention of allergies by dietetic means has become of great importance since it was possible to identify newborns at risk for allergies. The prolonged breast feeding and the late introduction of solids later than the sixth month of life is the preventive measure. "Hypoallergenic" formulae are not recommended because not enough solid data are available to confirm their preventive effect.
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PMID:[Food allergies]. 267 75

The authors treated 17 food allergic, 2-14 year old children with chemoprophylactic drugs. The patients got either ketotifen or DSCG in random allocated for 4 weeks and thereafter a washout period of 2 weeks separated the trial period of the other drug. Oral challenge with the food was performed before the trial period and after a 4 week lasting elimination diet on the last day of each treatment. After the ketotifen therapy in 10 of the 17 patients no symptoms appeared after the challenge, whereas only 5 patients were completely protected by DSCG. However, with regards to isolated organ symptoms the two drugs were of equal value. In case of failure of one drug the other was effective with two exceptions. Symptoms of intolerance (vomiting, angioedema or abdominal cramps) occurred in 3 patients during DSCG treatment and in one of those getting ketotifen. In 3 cases of severe milk allergy (Heiner-Holland syndrome) symptom-free state could be attained only if diet was supplemented by ketotifen. Symptoms of food allergy can be well prevented in children through ketotifen therapy more than by DSCG.
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PMID:Comparison of ketotifen and DSCG in treatment of food allergy in children. 310 6

Clinical effectiveness of ketotifen was evaluated in 15 children, aged 1-3 years, affected by atopic eczema likely due to food allergy. The study, lasting 15 weeks, was divided, according to the protocol, as follow: week run-in period with a restrictive diet; 8 week ketotifen therapy (the first 2 weeks with restrictive diet and the following 6 with free diet); 4 week follow-up phase with free diet. The adherence to treatment was complete in 11 patients; in 6 children symptomatology disappeared, 4 patients had fair improvement. The drug lasted only partially for a maximum 2 week period following the withdrawal. Side-effects (vomiting, enuresis, night restlessness) were moderate, short lasting and did not require the interruption of the protocol. Moreover, a mean 1 kg body weight increase was noticed.
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PMID:[Ketotifen in the treatment of pediatric atopic eczema]. 383 59

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. 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: 1) immediate syndromes, including anaphylaxis and b) acute vomiting +/- diarrhoea in association with cutaneous and respiratory manifestations; and 2) delayed syndromes, including a) food-sensitive small intestinal enteropathies, b) food-sensitive colitis, c) multiple food allergy +/- enteropathy, and d) infantile colic.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The spectrum of gastrointestinal allergies to food. 639 Dec 92

We report 8 infants with immediate hypersensitivity reactions to foods (milk, egg, or peanut), occurring at the first-known exposure. Each developed symptoms within the first hour, but these generally settled within 2 hours. Sensitisation to the food concerned was demonstrated by positive immediate allergen skin prick tests in every case. Symptoms experienced included irritability, erythematous rash, urticaria, angio-oedema, vomiting, rhinorrhoea, and cough. Five infants were being followed prospectively and 4 were clinically tolerant of the food by age 16 months. The most likely route of sensitisation was via breast milk. None of the infants experienced similar reactions while being breast fed, suggesting that the reaction was dose dependent. As 5 out of a group of 80 infants being followed prospectively developed an immediate reaction at their first known exposure to a food, this appeared to be a not uncommon presentation of food hypersensitivity in infancy.
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PMID:Immediate food hypersensitivity reactions on the first known exposure to the food. 684 27


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