Differentiating Food Allergies from Food Intolerances

Guandalini, Stefano; Newland, Catherine

doi:10.1007/s11894-011-0215-7

Cited by 34 publications

(24 citation statements)

References 44 publications

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“…6, 18 These two conditions can both present with nonspecific GI symptoms such as vomiting and/or diarrhea in infants and young children. 19 Therefore, health-care providers might initially diagnose these children with presumed food allergy before completing CD evaluation in suspected cases. The significant age-related differences in family history of CD were interesting but difficult to explain.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease

Tanpowpong

Broder‐Fingert

Katz

et al. 2012

Clinical and Translational Gastroenterology

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OBJECTIVES:Celiac disease (CD) is common and often cited as an “iceberg” phenomenon (i.e., an assumed large number of undiagnosed cases). Recently, atypical or asymptomatic manifestations are becoming more commonly described in older children and adolescents. Moreover, CD diagnosis in children can be complicated by several factors, including its diverse clinical presentations, delay in recognizing CD signs and symptoms, and premature dietary gluten avoidance before the formal diagnosis of CD. To date, few studies have directly examined age-related differences in clinical characteristics and gluten-related issues among children with CD. The aim of this study was to determine age-related patterns in clinical characteristics and gluten-related issues among children with confirmed CD.METHODS:We performed a structured medical record review of biopsy-proven CD patients, aged 0–19 years, between 2000 and 2010 at a large Boston teaching hospital. Data collection included demographics, medical history, gluten-related issues, and diagnostic investigations (CD-specific serology, upper gastrointestinal endoscopy, and small intestinal biopsy). The first positive duodenal biopsy with Marsh III classification defined age of diagnosis. Patients were divided into three age groups for comparisons of the aforementioned characteristics: infant-preschool group (0–5 years), school-aged group (6–11 years), and adolescence group (12–19 years).RESULTS:Among 411 children with biopsy-proven CD, the mean age was 9.5 (s.d. 5.1) years. Most were female (63%) and white (96%). All children had positive CD-specific serology. Most children presented with either abdominal complaints or bowel movement changes. Overall, boys were more common among infant-preschool group compared with the other age groups. More distinct clinical manifestations (vomiting, bowel movement changes, and weight issues) were apparent in the youngest group, whereas school-aged children had more subjective abdominal complaints at the initial presentation. Conversely, the adolescents were most likely to present without any gastrointestinal (GI) symptoms, but not when this was combined with absence of weight issues. Age of diagnosis was not associated with atypical extraintestinal CD presentations. Regarding the gluten-related issues, 10% of school-aged children avoided dietary gluten before the formal CD diagnosis, and 27% of the adolescents reported dietary gluten transgression within the first 12 months of diagnosis, significantly higher than the other age groups. Age differences in histopathology were also found. Whereas the infant-preschool group had a higher proportion of total villous atrophy, the older children were more likely to have gross duodenal abnormalities and chronic duodenitis suggestive of CD at the time of diagnosis.CONCLUSIONS:Children and adolescents with CD have age-related patterns in both the clinical presentations and gluten-related issues. More pronounced clinical and histological features were determined in younger children, whereas older children mo...

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Section: Discussionmentioning

confidence: 99%

Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease

Tanpowpong

Broder‐Fingert

Katz

et al. 2012

Clinical and Translational Gastroenterology

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“…They can be due to genetically defined metabolic specificities or to still other undefined causes (NIAID-Sponsored Expert Panel et al, 2010;Guandalini and Newland, 2011;Hayder and Bartholomaeus, 2011). They can be due to genetically defined metabolic specificities or to still other undefined causes (NIAID-Sponsored Expert Panel et al, 2010;Guandalini and Newland, 2011;Hayder and Bartholomaeus, 2011).…”

Section: Intolerance Reactionsmentioning

confidence: 99%

Guidance for submission for food additive evaluations

2012

EFS2

202

142

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<p>This guidance document refers to the applications for authorisation of a new food additive or to a modification of an already authorised food additive, combining in a single document the description of the data requirements and their context, and also a description of the risk assessment paradigm applied. The document is arranged in four main sections: chemistry and specifications, existing authorisations and evaluations, proposed uses and exposure assessment, and toxicological studies. Assessment of the exposure to food additives is based on information on known or anticipated human exposure to the proposed additive or toxicologically relevant components of the additive from food, and any other potential dietary sources. For the toxicological studies, this guidance describes a tiered approach which balances data requirements against the risk, taking into consideration animal welfare by adopting animal testing strategies in line with the 3-Rs (replacement, refinement, reduction). This tiered approach for toxicological studies consists of 3 tiers, for which the testing requirements, key issues and triggers are described. According to this tiered approach, a minimal dataset applicable to all compounds has been developed under Tier 1, while Tier 2 testing, generating more extensive data, will be required for compounds which are absorbed and/or demonstrate (geno)toxicity in Tier 1 tests. Tier 3 should be performed on a case-by-case basis taking into consideration all the available data, to elucidate specific endpoints needing further investigation of findings in Tier 2 tests. This guidance document replaces the previous guidance document by the Scientific Committee for Food published in 2001.</p>

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“…As previously mentioned, symptoms of allergy can often appear within the first month or two of life when passive immunity shifts to becoming more infant dependent. 13,20 However, in some cases, infants present with non-IgE-mediated sensitivities before 4 weeks of age, typically in the form of food proteininduced enterocolitis presenting as profuse vomiting, blood in the stool, diarrhea, or proctocolitis presenting as low-grade rectal bleeding. [18][19][20][21] At the onset of symptoms, the presence of blood can signify multiple causative factors.…”

Section: Food Allergies In Infantsmentioning

confidence: 99%

Optimizing the Microbiome and Immune System With Maternal Diet in Pregnancy and Lactation May Prevent Food Allergies in Infants

Hurd¹

2015

ICAN: Infant, Child, & Adolescent Nutrition

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Breast milk contains a perfect blend of macronutrients, vitamins, minerals, and water. This supports a baby’s nutritional needs exclusively for the first 6 months and beyond when paired with solid foods. Human milk also provides a unique blend of hormones, growth factors, and protective nutrients that support healthy functioning of the body as it matures, especially the microbiome within the digestive system. As a direct carrier of beneficial microbes, breast milk contains growth factors, oligosaccharides, lactoferrin, and lysozymes, which support the microbiome and immune system. These components regulate host–microbe interactions and establish the innate and adaptive immune response within the body. When the infant’s gastrointestinal tract is adequately colonized with an intact mucosal barrier, oral tolerance to antigens and pathogens creates a strong immune defense, avoiding expression of disease and atypical immune responses. There are many perinatal factors that affect the bacterial composition of breast milk and the maternal/infant gastrointestinal tract such as maternal body mass index, mode of delivery, perinatal antibiotic use, formula supplementation, and inflammation. Dysbiosis contributes to an increased expression of immune-mediated and allergic disease states. The impact of perinatal factors cannot always be prevented. When alternatives are not available, medical nutrition therapy can be key in supporting a healthy microbiome as well as improving maternal and infant gut function to prevent or treat food sensitivities. This article aims to address the role of maternal diet in pregnancy and lactation through optimizing the microbiome and immune system and reducing the infant allergy risk.

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Differentiating Food Allergies from Food Intolerances

Cited by 34 publications

References 44 publications

Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease

Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease

Guidance for submission for food additive evaluations

Optimizing the Microbiome and Immune System With Maternal Diet in Pregnancy and Lactation May Prevent Food Allergies in Infants

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