Posted by: Indonesian Children | October 17, 2010

Irritable bowel syndrome and Food allergy or Food Hypersensitivity.


Risk factors for irritable bowel syndrome in Turkish population: role of food allergy.

Uz E, Türkay C, Aytac S, Bavbek N.

J Clin Gastroenterol. 2007 Apr;41(4):380-3.

Department of Internal Medicine, Fatih University Medical School [corrected] Ankara, Turkey.

Erratum in:

  • J Clin Gastroenterol. 2007 Sep;41(8):795.



GOALS: The aim of this study was to determine the prevalence of food hypersensitivity in Turkish patients with irritable bowel syndrome (IBS).

BACKGROUND: The IBS is a chronic disease of the gastrointestinal tract characterized by abdominal pain, distension, meteorism and either diarrhea or constipation. The role of diet in the pathogenesis of IBS remains controversial. Many investigators have shown that individual foods can trigger symptoms in some patients; nevertheless, the percentage of patients that benefit from dietary manipulation ranges from 15% to 67% in different reports.

STUDY: Skin prick test to 11 common allergens, total IgE, eosinophilic cationic protein and eosinophil counts were evaluated in 100 patients satisfying the Rome II criteria and compared with 25 healthy controls. The history and physical examination of the groups were recorded and Beck Depression and Anxiety Inventories were performed.

RESULTS: One hundred patients were entered into the study with a mean age of 45.63+/-12.91 years. Of the patients 53 had constipation predominant, 19 had diarrhea predominant, and 28 had alternating type IBS. Skin prick tests positivity were more common among the IBS patients in comparison with controls (25% and 1%, respectively, P<0.05). Mean IgE values were higher in patients than controls (70.83+/-66.05 and 15.20+/-14.01 IU/mL, respectively, P<0.000). Eosinophilic cationic protein values were also higher in IBS patients than controls (16.75+/-11.28 and 11.56+/-4.72, respectively, P<0.05) Evaluation of Beck Depression Inventory showed that tendency to depression in patients with IBS was 38% and 4% in controls (P<0.05).

CONCLUSIONS: According to our results, in patients complaining of IBS it is of importance to search for a food component. Clinical improvements can be observed after the introduction of an adequate exclusion diet.

PMID: 17413606 [PubMed – indexed for MEDLINE]

Food hypersensitivity and irritable bowel syndrome.

Aliment Pharmacol Ther. 2001 Apr;15(4):439-49.

Zar S, Kumar D, Benson MJ.

Department of General Surgery, St George’s Hospital Medical School, London, UK.


Irritable bowel syndrome is a common condition but its pathophysiology remains poorly understood. Many irritable bowel syndrome patients give a history of food intolerance, but data from dietary elimination and re-challenge studies are inconclusive. Multiple aetio-pathological mechanisms have been postulated. The gut has an extensive immune system but current understanding of processing of food antigens in health and disease is limited. There is no clinically useful marker available to test for food hypersensitivity in irritable bowel syndrome. Researchers have employed both skin tests and serum immunoglobulins (IgG and IgE) as markers of food hypersensitivity in various disorders including irritable bowel syndrome, but published data are equivocal. In this article, the evidence for the role of food hypersensitivity in irritable bowel syndrome is reviewed and, based on the available data, a possible pathophysiological hypothesis has been formulated.

PMID: 11284772 [PubMed – indexed for MEDLINE]

Food allergy and irritable bowel syndrome.

Kalliomäki MA.

Curr Opin Gastroenterol. 2005 Nov;21(6):708-11.

Department of Paediatrics, University of Turku and Turku University Hospital, Finland.


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.

PMID: 16220050 [PubMed – indexed for MEDLINE]

Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia.

Zuo XL, Li YQ, Li WJ, Guo YT, Lu XF, Li JM, Desmond PV.

Clin Exp Allergy. 2007 Jun;37(6):823-30.

Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.

Comment in:



BACKGROUND: Post-prandial worsening of symptoms as well as adverse reactions to one or more foods are common in the patients with functional gastrointestinal diseases, such as irritable bowel syndrome (IBS) and functional dyspepsia (FD). However, the role played by true food allergy in the pathogenesis of these diseases is still controversial and there are no well-established tests to identify food allergy in this condition.

OBJECTIVE: To investigate serum food antigen-specific IgG, IgE antibody and total IgE antibody titres in controls and patients with IBS and FD, and to correlate symptoms with the food antigen-specific IgG titres in IBS and FD patients.

METHODS: Thirty-seven IBS patients, 28 FD patients and 20 healthy controls participated in this study. Serum IgG and IgE antibody titres to 14 common foods including beef, chicken, codfish, corn, crab, eggs, mushroom, milk, pork, rice, shrimp, soybean, tomatoes and wheat were analysed by ELISA. Serum total IgE titres were also measured. Last, symptomatology was assessed in the study. Results IBS patients had significantly higher titres of IgG antibody to crab (P=0.000), egg (P=0.000), shrimp (P=0.000), soybean (P=0.017) and wheat (P=0.004) than controls. FD patients had significantly higher titres of IgG antibody to egg (P=0.000) and soybean (P=0.017) than controls. The percentage of individuals with detectable positive food antigen-specific IgE antibodies of the three groups did not show any significant differences (P=0.971). There were no significant differences between IBS patients, FD patients and controls in the serum total IgE antibody titres (P=0.978). Lastly, no significant correlation was seen between symptom severity and serum food antigen-specific IgG antibody titres both in IBS and FD patients.

CONCLUSION: Serum IgG antibody titres to some common foods increased in IBS and FD patients compared to controls. But there is no significant correlation between symptom severity and elevated serum food antigen-specific IgG antibodies in these patients.

PMID: 17517095 [PubMed – indexed for MEDLINE]

[The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome]

Zhonghua Nei Ke Za Zhi. 2007 Aug;46(8):641-3.

[Article in Chinese]

Yang CM, Li YQ.

Department of Digestive Disease, Shandong Provincial Hospital, Jinan 250021, China.


OBJECTIVE: To explore the therapeutic effects on irritable bowel syndrome (IBS) by eliminating the allergic foods according to food-specific IgG antibodies and to clarify the etiopathological role and mechanism of food allergy.

METHODS: The food-specific IgG antibodies to a panel of 14 different food antigens in serum were detected with ELISA in fifty five cases with diarrhea-dominant IBS, thirty two with constipation-dominant IBS and eighteen normal controls. The frequency and severity index of symptoms and scores of Irritable Bowel Syndrome Quality of Life (IBS-QOL) in thirty five cases with positive food-specific IgG were observed before and after elimination of allergic foods for two months.

RESULTS: The positive rate of serum food-specific IgG antibodies was 63.6 percent in patients with diarrhea-dominant IBS and 43.8 percent in constipation-dominant IBS. Both were higher than that in normal controls. After eliminating allergic foods for four weeks according to the levels of serum food-specific IgG antibodies, the frequency of symptoms decreased from (3.79 +/- 1.58) to (1.67 +/- 0.70) per week and the severity from 3.18 +/- 1.46 to 1.52 +/- 0.67 with significant differences. After eight weeks, the frequency of symptoms decreased from (3.79 +/- 1.58) to (1.53 +/- 0.69) per week and the severity from 3.18 +/- 1.46 to 1.45 +/- 0.66, also with significant differences. After eliminating allergic foods, the overall health score and the eight dimensionality integrals of QOL except avoiding food in patients with IBS increased significantly than those before treatment. At the end of eight weeks, the symptoms relieved completely in 31.4 percent of the cases and remarkably in 34.3 percent.

CONCLUSIONS: Abnormal immune reactions mediated by IgG antibodies coexisted in patients with IBS. It is of great significance in treating IBS by eliminating the allergic foods according to the serum level of food-specific IgG antibodies.

PMID: 17967233 [PubMed – indexed for MEDLINE]

Role of food hypersensitivity in irritable bowel syndrome.

Zar S, Kumar D, Kumar D.

Minerva Med. 2002 Oct;93(5):403-12.

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.

PMID: 12410172 [PubMed – indexed for MEDLINE]


A cytologic assay for diagnosis of food hypersensitivity in patients with irritable bowel syndrome.

Clin Gastroenterol Hepatol. 2010 Mar;8(3):254-60. Epub 2009 Nov 22.

Carroccio A, Brusca I, Mansueto P, Pirrone G, Barrale M, Di Prima L, Ambrosiano G, Iacono G, Lospalluti ML, La Chiusa SM, Di Fede G.

Internal Medicine, Ospedali Civili Riuniti, Sciacca (Agrigento), Sciacca, Italy.


BACKGROUND & AIMS: A percentage of patients with symptoms of irritable bowel syndrome (IBS) suffer from food hypersensitivity (FH) and improve on a food-elimination diet. No assays have satisfactory levels of sensitivity for identifying patients with FH. We evaluated the efficacy of an in vitro basophil activation assay in the diagnosis of FH in IBS-like patients.

METHODS: Blood samples were collected from 120 consecutive patients diagnosed with IBS according to Rome II criteria. We analyzed in vitro activation of basophils by food allergens (based on levels of CD63 expression), as well as total and food-specific immunoglobulin (Ig)E levels in serum. Effects of elimination diets and double-blind food challenges were used as standards for FH diagnosis.

RESULTS: Twenty-four of the patients (20%) had FH (cow’s milk and/or wheat hypersensitivity); their symptom scores improved significantly when they were placed on an elimination diet. Patients with FH differed from other IBS patients in that they had a longer duration of clinical history, a history of FH as children, and an increased frequency of self-reported FH; they also had hypersensitivities to other antigens (eg, egg or soy). The basophil activation assay diagnosed FH with 86% sensitivity, 88% specificity, and 87% accuracy; this level of sensitivity was significantly higher than that of serum total IgE or food-specific IgE assays.

CONCLUSIONS: A cytometric assay that quantifies basophils after stimulation with food antigens based on cell-surface expression of CD63 had high levels of sensitivity, specificity, and accuracy in diagnosing FH. This assay might be used to diagnose FH in patients with IBS-like symptoms.

Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 19932763 [PubMed – indexed for MEDLINE]

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Clinical and Editor in Chief : Dr Widodo Judarwanto SpA, pediatrician

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