Introduction

Oral Allergy Syndrome

Coeliac Disease

Infantile Proctocolitis

Food Protein­induced Enterocolitis and Enteropathy

Introduction

The lining of the intestinal tract comes into direct contact with foodstuffs and is therefore at the frontline in defending the body against allergens. Food which the individual is allergic to will attack the gut lining first and foremost and then once having weakened it by the allergic reaction, allergen proteins will more easily pass through  to cause other symptoms in remote organs. The gastrointestinal tract is a common target organ for antibody mediated reactions to foods. Symptoms of gastrointestinal "anaphylaxis" occur shortly after the ingestion of an implicated food and include nausea, vomiting, abdominal pain and diarrhoea.

Oral Allergy Syndrome
The oral allergy syndrome is characterized by itching and oedema of the mouth (oral mucosa) occurring after the ingestion of certain fresh fruits and vegetables. Melons and mangoes can cause immediate reactions in certain individuals. The symptoms rarely progress beyond the mouth. The reaction occurs primarily in patients with allergic sensitivity to pollens and is caused by IgE antibodies directed toward cross-reacting proteins found in pollens, fruits and vegetables. Patients with birch-pollen hay fever may have symptoms of oral allergy syndrome after ingesting hazelnut, apple, carrot and celery, whereas patients with sensitivity to ragweed pollen may react to melons (e.g., watermelon or cantaloupe) and banana. Interestingly, patients are usually able to ingest cooked forms of the foods without symptoms because the responsible allergens are destroyed in the heating process. It is crucial to differentiate the symptoms of oral allergy syndrome from the early symptoms of a systemic reaction to food.  Oral allergy syndrome is limited to the mouth and upper throat whereas a general reaction will progress perhaps to anaphylaxis.

Coeliac Disease
A number of immunologic reactions to food proteins are not antibody or IgE reactions. Celiac disease presents over a period of months with steatorrhea, flatulence and weight loss. Hypersensitivity to gluten causes the disease, and medically speaking the characteristic diagnostic feature shows damage to the intestinal lining which shows up as flattening of villi in a biopsy specimen taken from the jejunal mucosa.

Allergic Eosinophilic Gastroenteritis
Allergic eosinophilic gastroenteritis is a true allergy -an antibody related condition (IgE-mediated) in half of sufferers and is not antibody related in the other fifty percent.  Allergic eosinophilic gastroenteritis causes severe gastric reflux, abdominal pain after meals, vomiting, feeling full early in the meal and  diarrhoea. The diagnosis is suggested by the presence of inflammation of the oesophagus which is infiltrated by certain white blood cells known as eosinophils. This may also be seen in the stomach or small intestine. Treatment with a strict avoidance diet is required.

Infantile Proctocolitis
The symptoms of infantile proctocolitis are inflammation of the rectum and lower colon and are of short duration. This is usually related to the baby being fed cow's-milk protein or breast milk from mothers who are consuming cow's milk. It provokes diarrhoea which may be bloody, but anaemia rarely occurs.

Food Protein­induced Enterocolitis and Enteropathy
Patients with colitis induced by food protein are often diagnosed as babies with profuse vomiting and diarrhoea. When severe, these symptoms may lead to lethargy, dehydration and hypotension mimicking bacterial infections. Improvement occurs with elimination of the responsible protein, most often cow's milk or soya.

Patients may also have more long term and persistent symptoms that are induced by milk, soy, egg, wheat, rice, chicken or fish. These patients are described as having food protein­induced enteropathy.

Infantile colic. The role of food protein sensitivity whether an allergic response or not, remains controversial in cases of infantile colic and inflammatory bowel disease remains controversial. Although failure to thrive in infants may be associated with malabsorption resulting from food allergy, a restrictive diet imposed by the family can also result in poor growth. Misdiagnosis of  food allergy in children can cause failure to thrive.

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