Allergic Disorders of Gastrointestinal System

Abstract

Abstract

Food induced gastrointestinal allergic disorders caused by certain food proteinsare characterized by eosinophilic inflammation on any site of the gastrointestinal system.These disorders caused by IgE or non-IgE-mediated immunological reactions that triggered by the food proteins. According to the type of immunological reaction, these disorders can be classified in three groups; IgE mediated, non-IGE-mediated andmixed type food induced allergic disorders. Food allergic reactions typically affects children more than adults; the prevalance in childhood can be as high as 8% while2% in adults. The overall most common allergens are cow’s milk, egg, cereals andsoy. Non IgE-mediated allergic disorders has an excellent prognosis that usually resolves itself by the age 1-3 and usually can not be possible to find the trigger allergen in most of the cases. There is stil an urgent need to define pathophysiological mechanisms of non-IgE-mediated food allergies and to develop diagnostic tools. Inthis review,  clinical characteristics, diagnostic perspectives and treatment options of the food induced gastrointestinal allergic disorders were summarized with the recent literature.

Keywords

• Food allergies,gastrointestinal allergic disorders,non-IgE-mediatedfood allergies

Gastrointestinal Sistemin Alerjik Hastalıkları

Öz

Öz

Gastrointestinal sistemin (GİS) alerjik hastalıkları besin alımına bağlı olarak ortaya çıkan, GİS’in herhangi bir bölümünde görülebilen, bir ya da birden fazla kat-manın etkilendiği eozinofilik inflamasyonla karakterize hastalıklardır. Bu hastalıklar besinlerin kendilerinin ya da içerdikleri herhangi bir maddenin meydana getirdiği immunolojik veya immunolojik olmayan mekanizmalarla tetiklenir. Ortaya çıkış mekanizmasına göre IgE aracılı, IgE aracılı olmayan ve mikst tip olmak üzere üçgrupta incelenir. Görülme sıklığı erişkinde %2 iken, çocukluk yaş grubunda %8’lere kadar çıkabilmektedir. En sık tetikleyici besinlerin inek sütü, yumurta, tahıllar ve soya olduğu bilinmektedir. Özellikle IgE aracılı olmayan GİS alerjilerinde tetikleyici besinin saptanması her zaman kolay olmayabilir ancak bu hastalıkların genellikle 1-3 yaş aralığında mükemmel bir prognozla iyileştiği bilinmektedir. Günümüzde henüz GİS alerjileri ile ilgili aydınlatılmamış birçok soru mevcuttur. Özellikle IgE aracılı olmayan grupta olanlar için geliştirilebilecek tanı araçları ile ilgili çalışmalar devam etmektedir. Bu derlemede, GİS allerjik hastalıklarında klinik bulgular, tanıve tedavi son literatür eşliğinde tartışılacaktır.

Anahtar Kelimeler

• Besin alerjisi,gastrointestinalsistem alerjiler,IgE olmayan besin alerjisi

References

1. Kaynaklar 1.Nowak-Wegrzyn A, Sampson HA. Adverse reactions to foods.Med Clin North Am. 2006 Jan;90(1):97-127. 2.Kuzu UB, Köksal AŞ. Eozinofilik gastrointestinal hastalıklar.Güncel Gastroenteroloji Dergisi 2014;18/3:342-351 3.Talley NJ. Eosionophilic gastroenteritis. In: Gastrointestinaland Liver Diseases. (Ed) Feldman M, Sleseinger M H. WMSaunders Company, Philadelphia 1998,pp:1679-88. 4.Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gas-troenterol 2005; 19:177-98. 5.Çolakoğlu B. Pathopysiology of food allergy. Türkiye Klinik-leri J Int Med Sci 2006; 2(41):1-4 6.(Arzu7) Tomaç N, Üstündağ G. Pathogenesis and clinical ma-nifestations of food allergy. Türkiye Klinikleri J Pediatr Sci2005;19:26-39. 7.Anderson LB Jr, Dreyfuss EM, Logan J, Johnstone DE, Gla-ser J.Melon and banana sensitivity coincident with ragweedpollinosis. J Allergy. 1970 May;45(5):310-9. 8.Uzuner N. Ölmez D., Babayiğit A. Gıda ile oluşan gastroin-testinal sistem aşırı duyarlılık Reaksiyonları. Türkiye Klinik-leri J Pediatr 2009;18(3):214-21 9.Amlot PL, Kemeny DM, Zachary C, Parkes P, Lessof MH. Oralallergy syndrome (OAS): symptoms of IgE-mediated hypersen-sitivity to foods. Clin Allergy. 1987 Jan;17(1):33-42 10.Sampson HA. Infantile colic and food allergy: fact or fiction?J Pediatr.1989 Oct; 115(4): 583-4 11.Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non-IgE-me-diated gastrointestinal food allergy. J Allergy Clin Immunol.2015 May;135(5):1114-24. 12.Elizur A, Cohen M, Goldberg MR, Rajuan N, Cohen A, Lesh-no M. et al. Cow's milk associated rectal bleeding: a popu-lation based prospective study.Pediatr Allergy Immunol.2012 Dec;23(8):766-70. 13.Xanthakos SA, Schwimmer JB, Melin-Aldana H, RothenbergME, Witte DP, Cohen MB. Prevalence and outcome of aller-gic colitis in healthy infants with rectal bleeding: a prospec-tive cohort study. J Pediatr Gastroenterol Nutr. 2005Jul;41(1):16-22. 14.Arvola T, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolau-ri E. Rectal bleeding in infancy: clinical, allergological, andmicrobiological examination. Pediatrics. 2006Apr;117(4):e760-8. 15.Lin XP, Magnusson J, Ahlstedt S, Dahlman-Höglund A, Han-son L LA, Magnusson O et al. Local allergic reaction in food-hypersensitive adults despite a lack of systemic food-specificIgE. J Allergy Clin Immunol. 2002 May;109(5):879-87. 16.Majamaa H, Miettinen A, Laine S, Isolauri E. Intestinal in-flammation in children with atopic eczema: faecal eosinop-hil cationic protein and tumour necrosis factor-alpha as non-invasive indicators of food allergy. Clin Exp Allergy. 1996Feb;26(2):181-7. 17.Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The pre-valence and natural course of food protein-induced entero-colitis syndrome to cow's milk: a large-scale, prospective po-pulation-based study.J Allergy Clin Immunol. 2011Mar;127(3):647-53 18.Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH,Sampson HA et al. Clinical features and resolution of food pro-tein-induced enterocolitis syndrome: 10-year experience. J Al-lergy Clin Immunol. 2014 Aug;134(2):382-9 19.Galip N, Hocaoğlu AB. Besin allerjilerinde tedavi; diyetin dü-zenlenmesi ve tolerans kontrolü. Turkiye Klinikleri J PediatrSci 2016;12(1):66-72 20.Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non-IgE-me-diated gastrointestinal food allergy. J Allergy Clin Immunol.2015 May;135(5):1114-24. 21.Machida HM, Catto Smith AG, Gall DG, Trevenen C, ScottRB. Allergic colitis in infancy: clinical and pathologic aspects.J Pediatr Gastroenterol Nutr. 1994 Jul;19(1):22-6. 22.Lake AM. Food-induced eosinophilic proctocolitis. J Pedi-atr Gastroenterol Nutr. 2000;30 Suppl:S58-60. 23.Odze RD, Bines J, Leichtner AM, Goldman H, Antonioli DA.Allergic proctocolitis in infants: a prospective clinicopatholo-gic biopsy study. Hum Pathol. 1993 Jun;24(6):668-74. 24.Winter HS, Antonioli DA, Fukagawa N, Marcial M, GoldmanH. Allergy-related proctocolitis in infants: diagnostic usefulnessof rectal biopsy. Mod Pathol. 1990 Jan;3(1):5-10. 25.Kokkonen J, Haapalahti M, Laurila K, Karttunen TJ, Mäki M.Cow's milk protein-sensitive enteropathy at school age. J Pe-diatr. 2001 Dec;139(6):797-803. 26.Walker-Smith JA. Cow milk-sensitive enteropathy: predis-posing factors and treatment. J Pediatr. 1992 Nov;121(5 Pt2):S111-5. 27.Lomidze N, Gotua T, Gotua M. Ige-mediated food allergy -current problems and future perspectives. Georgian Med News.2015 Jan;(238):73-8 28.Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheg-giano A, Federici T et al. Allergic proctocolitis refractory tomaternal hypoallergenic diet in exclusively breast-fed infants:a clinical observation.BMC Gastroenterol. 2011 Jul 16;11:82. 29.Katz Y, Goldberg MR. Natural history of food protein-indu-ced enterocolitis syndrome. Curr Opin Allergy Clin Immunol.2014 Jun;14(3):229-39. 30.Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whi-tehorn T, Spergel JM. Food protein-induced enterocolitissyndrome: insights from review of a large referral populati-on. J Allergy Clin Immunol Pract. 2013 Jul-Aug;1(4):343-9. 31.Zapatero Remón L, Alonso Lebrero E, Martín Fernández E,Martínez Molero MI. Food-protein-induced enterocolitissyndrome caused by fish. Allergol Immunopathol (Madr). 2005Nov-Dec;33(6):312-6. 32.Maloney J, Nowak-Wegrzyn A. Educational clinical case se-ries for pediatric allergy and immunology: allergic proctoco-litis, food protein-induced enterocolitis syndrome and aller-gic eosinophilic gastroenteritis with protein-losing gastroen-teropathy as manifestations of non-IgE-mediated cow's milkallergy. Pediatr Allergy Immunol. 2007 Jun;18(4):360-7.