Curr Opin Gastroenterol. 2005 Nov;21(6):708-11.
Food allergy and irritable bowel syndrome.
Department of Paediatrics, University of Turku and Turku University Hospital, Finland. email@example.com
PURPOSE OF REVIEW: Irritable bowel syndrome is a common and likely a multifactorial gastrointestinal disorder in which a disturbed brain-gut axis has been thought to have a mandatory role. Recent clinical and experimental studies imply that dietary factors may be more important in the pathogenesis of irritable bowel syndrome than was earlier anticipated. The purpose of this review is to present those studies and discuss their findings in relation to the crosstalk between the gastrointestinal immune and nervous systems. RECENT FINDINGS: Food elimination based on serum immunoglobulin G antibodies in irritable bowel syndrome has been found to result in a significant decrease in symptoms, compared with diets in which dietary restrictions are not guided by those antibodies. Both numbers of mast cells and their mediators have been shown to be increased in intestinal mucosa in patients with irritable bowel syndrome, especially in the close proximity of intestinal nerves. Animal studies have demonstrated that this increase in intestinal mast cell density could be a consequence of local hypersensitivity to food antigens. That kind of local gastrointestinal hypersensitivity seems to be beyond the reach of current diagnostic methods available in clinical practice. SUMMARY: Dietary factors may significantly contribute to the pathophysiology of irritable bowel syndrome. Elimination diets based on the detection of local food hypersensitivity may offer a treatment option for irritable bowel syndrome patients in the future.
Orv Hetil. 2005 Apr 24;146(17):797-802.
[Increased IgE-type antibody response to food allergens in irritable bowel syndrome and inflammatory bowel diseases]
[Article in Hungarian]
Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar, Belgyógyászati Intézet, III. Belgyógyászati Klinika. firstname.lastname@example.org
BACKGROUND: The irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms of abdominal pain that is associated with disturbed defecation. Crohn’s disease (CD) and Ulcerative colitis (UC) are collectively referred to as inflammatory bowel diseases (IBD). IBD appears to result from dysregulated immune response with contributions from genetic predisposition and environmental factors. Among environmental factors the enteric microflora and the components of food (eg. antigens) may play important role in the pathogenesis of IBD. The aim of the authors’ study was to detect IgE type antibodies against the most frequent food allergens in patients with IBD and IBS. METHODS: Antibodies against food allergens (IgE type) with ELISA method in patients with CD, UC and IBS were quantitatively measured. The figures were compared to the result of a healthy control group contains the same number of participants, and the frequency of food allergy in these patient groups were determined. RESULTS: On the basis of the study the presence of increased IgE type immune response against any food allergens was 34.5% (p = 0.01) in the group of IBS. In patients with CD or UC the immune response against food allergens was also more frequent than in the control group. The order of frequency of food allergens in IBS was the following: milk protein, soybean, tomato, peanut, egg white. CONCLUSION: As the occurrence of food allergens was significantly higher in IBS group than in the control group, the role of food allergy in the symptoms of IBS can be come up. The frequency of food allergy in patients with diagnosis of IBS, and the similarity of symptoms of this two diseases give an obvious opportunity for the patients with IBS to use a diet avoiding the most frequent food allergens, or take e.g. Na-cromoglycate which is useful therapy in food allergy.
Neurogastroenterol Motil. 2006 Aug;18(8):595-607.
Is there a role of food allergy in irritable bowel syndrome and functional dyspepsia? A systematic review.
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) Group, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
A significant proportion of adults believe they suffer from food allergy, and 20-65% of patients with irritable bowel syndrome (IBS) attribute their symptoms to something in food that activates an abnormal response. This systematic review evaluates the role of food allergy in aetiology and management of these disorders. Activation of gastrointestinal mucosal immune system may be one of the causative factors in the pathogenesis of functional dyspepsia and IBS. This activation may result from effects of bacterial infection or other luminal factors including commensal microbial flora and food antigens. Some studies have reported on the role of food allergy in IBS; only one epidemiological study on functional dyspepsia and food allergy has been published. The mechanism by which food activates mucosal immune system is uncertain, but food specific IgE and IgG4 appeared to mediate the hypersensitivity reaction in a subgroup of IBS patients. Exclusion diets based on skin prick test, RAST for IgE or IgG4, hypoallergic diet and clinical trials with oral disodium cromoglycate have been conducted, and some success
Minerva Med. 2002 Oct;93(5):403-12.
Role of food hypersensitivity in irritable bowel syndrome.
OGEM Department, St. Georges Hospital Medical School, London, UK.
A significant proportion of IBS patients attribute their symptoms to adverse food reactions. Dietary elimination and re-challenge studies support the role of diet in the pathogenesis of IBS. The aetiopathogenesis of IBS is thought to be multifactorial involving an interaction between diet, infection, antibiotics and psychosocial factors. Serum IgE and IgG4 antibodies are elevated in food hypersensitivity induced atopic conditions and a similar mechanism has been postulated in IBS. Increased number of mast cells is present in the ileocaecal region of IBS patients. Once sensitized, they are capable of inducing secretory and sensorimotor abnormalities of the gut. The management of IBS is usually aimed at controlling symptoms, however, evaluation of food hypersensitivity may provide a useful adjunct in those with severe symptoms or a clear history of adverse food reaction. There are no well-established tests available but skin prick tests and food specific serum IgG4 and IgE antibodies may help in identifying the offending foods. Other options, which may be explored in individual cases, include sequential dietary exclusion, use of hypoallergenic diets, disodium cromoglycate and novel techniques such as colonoscopic allergen provocation test. Pathophysiology of hypersensitivity induced IBS has been discussed in the light of current data and a management algorithm has been proposed for managing food hypersensitivity in IBS.
Gut. 2004 Oct;53(10):1391-3.
Food allergy in irritable bowel syndrome: new facts and old fallacies.
Department of Paediatrics, Turku University Central Hospital, 20520 Turku, Finland. email@example.com
The notion of food allergy in irritable bowel syndrome (IBS) is not new. However, recent evidence suggests significant reduction in IBS symptom severity in patients on elimination diets, provided that dietary elimination is based on foods against which the individual had raised IgG antibodies. These findings should encourage studies dissecting the mechanisms responsible for IgG production against dietary antigens and their putative role in IBS
Gut. 2004 Oct;53(10):1459-64.
Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial.
Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK.
- Gut. 2004 Oct;53(10):1391-3.
- Gut. 2005 Aug;54(8):1203; author reply 1203.
- Gut. 2005 Apr;54(4):567.
- Gut. 2005 Apr;54(4):566.
BACKGROUND: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies. AIMS: To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. PATIENTS: A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies. METHODS: Primary outcome measures were change in IBS symptom severity and global rating scores. Non-colonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model. RESULTS: After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18-88); p = 0.003). CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
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