Non-IgE-mediated food hypersensitivity

Abstract

Non-immunoglobulin E (IgE)-mediated food hypersensitivity includes a spectrum of disorders that predominantly affect the gastrointestinal tract. This review will focus on the following more common non-IgE-mediated food hypersensitivity syndromes: food protein-induced enterocolitis syndrome (FPIES), allergic proctocolitis (AP), food protein-induced enteropathy (FPE) and celiac disease. FPIES, AP and FPE typically present in infancy and are most commonly triggered by cow’s milk protein or soy. The usual presenting features are profuse emesis and dehydration in FPIES; blood-streaked and mucousy stools in AP; and protracted diarrhea with malabsorption in FPE. Since there are no confirmatory noninvasive diagnostic tests for most of these disorders, the diagnosis is based on a convincing history and resolution of symptoms with food avoidance. The mainstay of management for FPIES, AP and FPE is avoidance of the suspected inciting food, with periodic oral food challenges to assess for resolution, which generally occurs in the first few years of life. Celiac disease is an immune-mediated injury caused by the ingestion of gluten that leads to villous atrophy in the small intestine in genetically susceptible individuals. Serologic tests and small intestinal biopsy are required to confirm the diagnosis of celiac disease, and management requires life-long adherence to a strict gluten-free diet.

The Consequence of Excessive Consumption of Cow’s Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia—Case Reports and a Literature Review

“…It is important to note that non-IgE-mediated CMPA should be considered in the diagnosis of any patient presenting the following symptoms: Prolonged diarrhea, abnormal growth, recurrent vomiting, flatulence, blood in the stools, IDA, or other mild gastrointestinal disorders not responding to standard treatment [ 29 , 30 ]. This diagnosis is strengthened by the presence of skin lesions and/or respiratory symptoms.…”

Mechanisms of allergen-specific immunotherapy for allergic rhinitis and food allergies

“…FA is defined as an adverse immunological reaction to food [8,15], which may be IgE-mediated, non-IgE mediated (cell-mediated) or mixed (IgE and cell-mediated). IgE-mediated food reactions usually occur within minutes to 2 hours after exposure to allergen [16,17] while non-IgE-mediated food reactions are typically delayed from hours to weeks after intake of the allergen [18]. FA are diagnosed based on detailed clinical history and physical examination together with skin-prick test or serum-specific IgE testing, elimination diet for diagnostic purposes and oral food challenge [19].…”

“…FA are diagnosed based on detailed clinical history and physical examination together with skin-prick test or serum-specific IgE testing, elimination diet for diagnostic purposes and oral food challenge [19]. For non-IgE-mediated FA, patients will have negative results for skin-prick test or specific IgE but positive for oral food challenge or responsive to a trial of elimination of the suspected offending food [18]. In this review, we will focus on IgE-mediated FA, which has been studied and documented much more in-depth than non-IgE-mediated FA.…”

Anaphylaxis in Pregnancy in the United States: Risk Factors and Temporal Trends Using National Routinely Collected Data

“…It commonly occurs when allergens trigger an IgE-mediated cascade causing mast cell activation, resulting in an anaphylactic reaction 2 . In addition, severe hypotensive reactions can occur through non–IgE-mediated mechanisms; however, these reactions are less common 3, 4, 5…”