Is there a role of food allergy in irritable bowel syndrome and functional dyspepsia? A systematic review

Abstract

A significant proportion of adults believe they suffer from food allergy, and 20-65% of patients with irritable bowel syndrome (IBS) attribute their symptoms to something in food that activates an abnormal response. This systematic review evaluates the role of food allergy in aetiology and management of these disorders. Activation of gastrointestinal mucosal immune system may be one of the causative factors in the pathogenesis of functional dyspepsia and IBS. This activation may result from effects of bacterial infection or other luminal factors including commensal microbial flora and food antigens. Some studies have reported on the role of food allergy in IBS; only one epidemiological study on functional dyspepsia and food allergy has been published. The mechanism by which food activates mucosal immune system is uncertain, but food specific IgE and IgG4 appeared to mediate the hypersensitivity reaction in a subgroup of IBS patients. Exclusion diets based on skin prick test, RAST for IgE or IgG4, hypoallergic diet and clinical trials with oral disodium cromoglycate have been conducted, and some success has been reported in a subset of IBS patients. Further well-controlled studies are needed to establish whether food allergy plays a role in the pathophysiology of functional dyspepsia and IBS.

Lipopolysaccharides Facilitate Colonic Motor Alterations Associated to the Sensitization to a Luminal Antigen in Rats

“…Dietary-related IBS-like responses have been associated, both in patients and animal models, to local mechanisms of the colonic mucosa rather than a systemic reaction, more characteristic of food allergies. 4,6,7 In agreement with these observations, in this study, OVA-induced altered contractility in OVA-LPStreated rats was neither related to the presence of circulating specific IgEs (unpublished results) nor to the altered expression of pro-(IL-6 and IL-13) or anti-allergic (IL-12 and IL-10) cytokines. 26,27 However, these animals showed a specific up-regulation of IFN-1, similar to that observed in IBS-like states.…”

“…4,6 In this line, we have previously demonstrated that long-term exposure to oral ovalbumin (OVA), without adjuvants, results in a non-IgE mediated alteration of colonic motility in rats, an effect related to an excited-activated state of the tissue mucosal mast cells (MMCs). These OVA-mediated changes are reminiscent of those observed in IBS patients and in animal models of the disease.…”

Discrepancies between the responses to skin prick test to food and respiratory antigens in two subtypes of patients with irritable bowel syndrome

“…D-IBS, [14] . The contents of glycerinated food extracts (1:20), the positive control substance, histamine, and the negative control substance, saline, were commercially available (M Queiroz Laboratory, Rio de Janeiro, Brazil).…”

“…A wheal that was 3 mm greater than that of the negative control was considered positive. Anything less was considered negative [14] .…”

“…Recent interest has also been directed to the possible participation of the mucosa in the pathophysiology of IBS [11][12][13] . Inflammatory mediators cause intestinal dysfunction and a consequent increase in permeability [14][15][16][17] . However the role and interaction of inflammatory mediators with IBS remains to be determined [17] .…”