Oesophagitis in children: reflux or allergy?

Ireland-Jenkin, Kerryn; Wu, Xiangru; Heine, Ralf G.; Cameron, Donald J. S.; Catto‐Smith, Anthony G.; Chow, C. W.

doi:10.1080/00313020701813727

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…The inflammatory response may cause bleeding, with blood in the vomit. Gastro-oesophageal reflux disease can occur as an adverse reaction to food, particularly in children, with or without development of eosinophilic oesophagitis (Moon and Kleinman, 1995;Ireland-Jenkin et al, 2008;Dalby et al, 2010).…”

Section: Vomiting and Gastro-oesophageal Reflux Diseasementioning

confidence: 99%

Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes

Products¹

2014

EFS2

117

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Following a request from the Food Safety Authority of Ireland, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA Panel) was asked to deliver a scientific opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. In view of the request, the NDA Panel decided to update its previous opinions relative to food ingredients or substances with known allergenic potential listed in Annex IIIa of 2003/89/EC, as amended. These include cereals containing gluten, milk and dairy products, eggs, nuts, peanuts, soy, fish, crustaceans, molluscs, celery, lupin, sesame, mustard and sulphites. The opinion relates to immunoglobulin (Ig)E-and non-IgE-mediated food allergy, to coeliac disease and to adverse reactions to sulphites in food, and it does not address non-immune-mediated adverse reactions to food. It includes information on the prevalence of food allergy in unselected populations, proteins identified as food allergens, cross-reactivities, the effects of food processing on the allergenicity of foods and ingredients, methods for the detection of allergens and allergenic foods, doses observed to trigger adverse reactions in sensitive individuals and risk assessment methodologies that have been used to derive individual and population thresholds for selected allergenic foods. The present opinion relates to immunoglobulin (Ig)E-and non-IgE-mediated food allergy, to coeliac disease and to adverse reactions to sulphites in food, and it does not address non-immune-mediated adverse reactions to food. For each food ingredient or substance listed in Annex IIIa, it includes information on the prevalence of food allergy in unselected populations, on proteins identified as food allergens, on cross-reactivities, on the effects of food processing on the allergenicity of foods and ingredients, on methods for the detection of allergens and allergenic foods, and on doses observed to trigger adverse reactions in sensitive individuals.Immune-mediated adverse reactions to foods manifest with clinical signs and symptoms of variable severity and duration, which may affect different organs and systems. Anaphylactic reactions to food are IgE mediated and may occur at any age. Non-IgE-mediated food allergy includes a wide range of diseases, including protein-induced enterocolitis and eosinophilic oesophagitis.A careful family and clinical history are the basis for diagnosis of food allergy. Food diaries, skin prick tests (SPTs), allergen-specific IgE measurements, food elimination diets and food challenges are part of the standard protocol for the diagnosis of food allergy. A positive SPT indicates sensitisation to the tested food, but it is not diagnostic of food allergy. Allergen-specific serum IgE antibodies similarly denote sensitisation to a particular food, but they are not diagnostic without a clinical history or food challenge. The use of atopy patch tests for the diagnosis of food allergy is controversial. Other available tests have no current role in the diagnosis of food allergy. Diag...

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Section: Vomiting and Gastro-oesophageal Reflux Diseasementioning

confidence: 99%

Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes

Products¹

2014

EFS2

117

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“…The classic endoscopic finding is of a ringed appearance described as "trachealization". Longitudinal ridging, strictures, white plaques, erythema, erosions, and a loss of vascularity may also be seen (11,12). Endoscopic features are not always present, however, indicating the importance of mucosal biopsies when EE is likely (12).…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic esophagitis and food impaction: an instructive case

Tilakaratne

Day²,

Lemberg³

2012

Turk J Gastroenterol

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“…It has been suggested that release of proinflammatory mediators from activated T cells and degranulated eosinophils may stimulate the ENS and cause peristaltic dysfunction or trigger TLOSRs (1, 4, 8, 9, 21–23). The absolute number of mucosal eosinophils in food protein‐induced GORD is not increased (≤5/HPF) which distinguishes it from eosinophilic oesophagitis (eosinophils in upper and lower oesophageal biopsies ≥15–20/HPF) (24, 25).…”

Section: Casementioning

confidence: 99%

“…Gastroscopy and grasp biopsies provide more useful diagnostic clues to guide the need for acid‐suppressive therapy, or to rule out eosinophilic oesophagitis, as well as other food protein‐induced upper gastrointestinal pathology (27, 28). Histological features of reflux oesophagitis include a low number of mucosal eosinophils (≥5/HPF) in lower oesophageal biopsies, in conjunction with basal layer hyperplasia, neutrophils and epithelial ulceration as evidence of acid–peptic injury (24). Eosinophilic oesophagitis is characterized by larger numbers of mucosal eosinophils (>15–20/HPF) in the upper and lower oesophagus, without mucosal ulceration or neutrophilia (29).…”

Section: Casementioning

confidence: 99%

Allergic gastrointestinal motility disorders in infancy and early childhood

Heine

2008

Pediatric Allergy Immunology

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Gastro-oesophageal reflux disease, constipation and colic are among the most common disorders in infancy and early childhood. In at least a subset of infants with these functional disorders, improvement after dietary elimination of specific food proteins has been demonstrated. Gastrointestinal food allergy should therefore be considered in the differential diagnosis of infants presenting with persistent regurgitation, constipation or irritable behaviour, particularly if conventional treatment has not been beneficial. The diagnosis of food protein-induced gastrointestinal motility disorders is hampered by the absence of specific clinical features or useful laboratory markers. Gastrointestinal biopsies before commencing a hypoallergenic diet may provide the most important diagnostic clues. Early recognition is essential for the optimal management of these patients to prevent nutritional sequelae or aversive feeding behaviours. Treatment relies on hypoallergenic formulae, as well as maternal elimination diets in breast-fed infants. Further research is required to better define the pathological mechanisms and diagnostic markers of paediatric allergic gastrointestinal motility disorders. The following article will present three instructive cases followed by discussion of the clinical presentation, diagnosis, treatment and natural history of food allergic motility disorders in infancy and early childhood.

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Oesophagitis in children: reflux or allergy?

Cited by 18 publications

References 26 publications

Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes

Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes

Eosinophilic esophagitis and food impaction: an instructive case

Allergic gastrointestinal motility disorders in infancy and early childhood

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