|AGA technical review:
Evaluation of food allergy in gastrointestinal disorders
This literature review and the recommendations therein were prepared for the American Gastroenterological Association (AGA) Clinical Practice and Practice Economics Committee. The paper was approved by the committee on September 23, 2000, and by the AGA Governing Board on November 12, 2000.
Published in Gastroenterology 2001; 120:1026. Copyright 2001 American Gastroenterological Association.
This is the technical review for the AGA guideline on food allergies. (See “AGA guideline: Evaluation of food allergies”).
The term food allergy refers to an adverse immunologic response to proteins in food [1,2] ; it is thus to be distinguished from other, more common, adverse reactions to foods that are designated food intolerance. Adverse reactions caused by food intolerance may result from particular constituents within foods, such as toxins (eg, food poisoning) or pharmacologic agents (eg, caffeine or tyramine), or from host factors such as metabolic disorders (ie, lactase deficiency). The aim of this technical review is to provide a rational approach to the evaluation of food allergy in gastrointestinal disorders by:
- Providing a conceptual framework through a brief review of the clinical manifestations of food allergy and their presumed pathophysiology
- Reviewing particular gastrointestinal disorders/symptom complexes that may be associated with food allergy
- Reviewing diagnostic approaches to food allergy
Because food allergy is not a single disorder, but rather immunopathologic mechanisms underlying a number of defined or poorly defined gastrointestinal disorders/symptom complexes, a variety of strategies were undertaken in selecting articles for this review. MEDLINE searches were conducted for peer-reviewed clinical studies of particular disorders using MeSH (National Library of Medicine Medical Subject Headings) terms for the disorder plus the term “food hypersensitivity.” In addition, more general searches were conducted for food hypersensitivity disorders. However, the lack of standard approaches to evaluate food allergy, overlap of clinical manifestations of various disorders, the preponderance of case reports or small, uncontrolled studies, and deficiencies in study design frequently limited the conclusions that could be drawn and precluded meta-analyses. To develop recommendations for evaluating the possibility of food allergy in patients with various clinical syndromes/ symptoms, this report highlights results from larger, controlled studies; approaches from placebo-controlled, blinded studies; and consensus panel reports.
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