Food Hypersensitivity Reactions Visualised by Ultrasonography and Magnetic Resonance Imaging in a Patient Lacking Systemic Food-Specific IgE

Abstract

Background: Abdominal complaints related to food intake might be due to hypersensitivity. A firm diagnosis of food allergy is often difficult to establish, particularly in the absence of systemic food-specific IgE. Using ultrasonography and magnetic resonance imaging (MRI) we were able to visualise the intestinal response in one such case. Methods: A 24-year-old female presented with self-reported food hypersensitivity, particularly related to the intake of egg. Nausea and diarrhoea were predominant symptoms. Double-blind placebo-controlled food challenge with raw egg was positive, but all other conventional tests of food hypersensitivity, including skin prick test, total and food-specific IgE in serum, were negative. A thorough investigation programme could not reveal any organic disease of the gastrointestinal tract. We extended the evaluation to include two new provocation tests, where intestinal wall thickening and the amount of luminal liquid were monitored by external abdominal ultrasound and MRI. Results: Both ultrasound and MRI investigations indicated intestinal wall thickening and influx of large amounts of fluid into the proximal small intestines within 10 min of duodenal challenge with egg. The response was associated with abdominal pain and bloating. Conclusions: The response to provocation was typical of an immediate allergic reaction. Our results indicate that local food-induced hypersensitivity reactions can occur in the gut in the absence of systemic indications of IgE-mediated allergy. Abdominal ultrasonography and MRI might become valuable tools for documenting such responses.

Food allergy alters jejunal circular muscle contractility and induces local inflammatory cytokine expression in a mouse model

“…In contrast to the findings in the parasite model, though, we found no evidence of hypertrophy of the smooth muscle layers. Nevertheless, an altered responsiveness to a cholinomimetic, as seen in our allergy model, may well reflect an allergen-induced defence mechanism with a bearing to the disturbed small intestinal motility pattern seen in intestinal anaphylaxis [19] and in patients with food hypersensitivity [20-22]. Interestingly, colonic hypocontractility [23] and thinning of duodenal and colonic smooth muscle layers [24] has been described in other food allergy models.…”

Perceived food hypersensitivity: A review of 10 years of interdisciplinary research at a reference center

“…Indeed, we were able to visualize local intestinal reactions in response to direct intraduodenal administration of suspected allergens (luminal provocation) using both endoscopic and transabdominal ultrasonography, as well as magnetic resonance imaging [9][10][11]. A rapid intestinal response to direct food challenge, characterized by thickening of the intestinal wall, increased peristalsis and influx of large amounts of fluid into the intestinal lumen, was seen.…”

Advanced imaging and visualization in gastrointestinal disorders

“…any resolvable wall thickening of the duodenum, contraction or new echogenic l a y e r ) w e r e o b s e r v e d i n m a n y p a t i e n t s w i t h f o o d hypersensitivity. Increased mucosal thickness associated with a new echogenic layer was seen in two patients [82] .…”

“…Particularly in the absence of systemic food-specific IgE, a firm diagnosis of food allergy is difficult. Using ultrasonography and MRI we were able to visualise the intestinal response in one such case [82] . A 24-year-old female presented with self-reported food hypersensitivity, particularly related to intake of egg.…”