Allergic Gut Problems
Adverse reactions to food
Food allergy
Defined as an abnormal immunological response to food (incidence is 6–8% in children aged <3yrs).
• Immediate allergic reactions involve production of food-specific IgE antibodies.
• 70% of cases have a family history of atopy.
• Allergy becomes less common as age increases.
• The commonest food allergens are cow’s milk proteins, eggs, peanuts, wheat, soya, fish, shellfish, and tree nuts.
Common types of Allergic Gut problems:
Food Allergy or Hypersensitivity
Type I (IgE-mediated) immediate hypersensitivity reactions to foods are most common in young children, with 50% of these reactions occurring in the first year of life. The majority are reactions to cow’s milk or to soy protein from infant formulas.Other food allergies begin to predominate in older children, including egg, fish, peanut, and wheat. Together with milk and soy, these account for more than 90% of food allergy in children.
Eosinophilic Gastroenteropathies
The eosinophilic gastroenteropathies are an interesting yet somewhat poorly defined set of disorders that must include the infiltration of at least one layer of the GI tract with eosinophils, in the absence of other known causes for eosinophilia (e.g., parasitic infections or drug reactions)
Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is characterized by an isolated, severe eosinophilic infiltration of the esophagus manifested by gastroesophageal reflux-like symptoms, but refractory to typical reflux therapies. This disorder has been given several names including eosinophilic esophagitis, allergic esophagitis, primary eosinophilic esophagitis, and idiopathic eosinophilic esophagitis.
Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis (EoG) is a general term that describes a constellation of symptoms attributable to the GI tract, in combination with pathologic infiltration by eosinophils. This group includes eosinophilic gastritis, gastroenteritis, and enterocolitis. There are no strict diagnostic criteria for this disorder, and it has been largely shaped by multiple case reports and series. A combination of GI complaints with supportive histologic findings is sufficient to make the diagnosis.
Eosinophilic Proctocolitis
Eosinophilic proctocolitis (EoP), also known as allergic proctocolitis (AP) or milk-protein proctocolitis, has been recognized as one of the most common etiologies of rectal bleeding in infants. This disorder is characterized by the onset of rectal bleeding, generally in children less than 2 months of age.
Eosinophilic disorders of the GI tract are becoming increasingly recognized as distinct clinical entities with specific management strategies. Whereas EoG is rare and difficult to diagnose, EoP and EoE are much more common and easily diagnosed by endoscopic biopsy. Although EoP is a well-accepted entity, the diagnosis of EoE has recently been receiving a great deal of attention. Recent literature suggests a miniepidemic of EoE in the pediatric population, though controversy still exists regarding the etiology and treatment.
Adverse reactions to food
Food allergy
Defined as an abnormal immunological response to food (incidence is 6–8% in children aged <3yrs).
• Immediate allergic reactions involve production of food-specific IgE antibodies.
• 70% of cases have a family history of atopy.
• Allergy becomes less common as age increases.
• The commonest food allergens are cow’s milk proteins, eggs, peanuts, wheat, soya, fish, shellfish, and tree nuts.