Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(Suppl 1) > 1043490

Korean J Pediatr Gastroenterol Nutr. 2010 Dec;13(Suppl 1):S32-S43. Korean.
Published online December 31, 2010.  https://doi.org/10.5223/kjpgn.2010.13.Suppl1.S32
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
The Diagnosis of Food Allergy in a Pediatric Gastroenterology: Focusing on Non-IgE-mediated Allergic Diseases
Kun Song Lee, M.D.
Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea.

Corresponding author (Email: pdlks@hanmail.net )
Received November 24, 2010; Accepted November 30, 2010.

Abstract

Food allergy is an adverse immune response to foods. The prevalence of food allergy vary by age, diet, and many other factors. Based on the immunological mechanism, food allergies may be classified in a IgE-mediated diseases, which are the best-characterized food allergy reactions, non-IgE-medicated diseases, and mixed type diseases. In children, the GI tract seems to be the most common target organ. Generally, IgE-mediated reactions have an acute onset, whereas non-IgE-mediated reactions have a late onset. The most food allergy with GI manifestation involve non-IgE-mediated reactions. The evaluation of a child with suspected food allergy includes medical history, physical examination, screening test and the response to elimination diet and to oral food challenge. The diagnosis of non-IgE-mediated food allergies using a screening test is difficult. In this review, investigate the diagnostic criteria and manifestations of several non-IgE-mediated allergic diseases and the diagnostic method in the field of a pediatric gastroenterology.

Keywords: Food allergy; Non-IgE-mediated reactions; Pediatric gastroenterology

Figures


Fig. 1
Evaluation of a child with suspected food allergy.
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Fig. 2
Measurement for skin prick test.
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Fig. 3
Procedures for diagnosis of eosinophilic esophagitis.
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Fig. 4
Algorithm after oral cow's milk challenge for diagnosis of typical cow's milk protein-induced enterocolitis. Adapted from ref. 26.
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Fig. 5
Selection of type of food challenge according to age and symptoms. Adapted from ref. 22.
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Tables


Table 1
Classification of Gastrointestinal Hypersensitivities to Food and Other Dietary Products
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Table 2
The Seven Groups of Gastrointestinal Cow Milk Allergy in Infants
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Table 3
Principal Characteristics of Allergic Proctocolitis
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Table 4
Principal Characteristics of Food-Induced Enterocolitis Syndrome
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Table 5
Most common Age-Related Clinical Manifestations of EOE
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Table 6
Classification of Eosinophilic Gastroenteritis
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Table 7
Major Symptoms of Eosinophilic Gastroenteritis Depending on the Localization of Disease
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Table 8
Clinical Features Suggestive of Food Protein-Induced Gastrointestinal Motility Disorders In Infants and Young Children
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Table 9
Grading System for Skin Prick Test
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Table 10
Predictive Values of Food Allergen-Specific Immunoglobulin E Levels
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Table 11
Diagnostic Guideline of Esosinophilic Esophagitis
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Table 12
Histologic Features Associated with EE
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Table 13
Oral food challenge in food protein-induced enterocolitis syndrome
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References
1. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol 2010;125:S116–S125.
2. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Pediatr Allergy Respir Dis 2008;18:15–25.
3. Cianferoni A, Spergel JM. Food allergy: review, classification and diagnosis. Allergol Int 2009;58:457–466.
4. Husby S. Food allergy as seen by a paediatric gastroenterologist. J Pediatr Gastroenterol Nutr 2008;47 Suppl 2:S49–S52.
5. Chehade M. IgE and non-IgE-mediated food allergy: treatment in 2007. Curr Opin Allergy Clin Immunol 2007;7:264–268.
6. Garcia-Careaga M Jr, Kerner JA Jr. Gastrointestinal manifestations of food allergies in pediatric patients. Nutr Clin Pract 2005;20:526–535.
7. Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr 2000;30 Suppl:S87–S94.
8. Hwang JB, Choi SY, Kwon TC, Oh HK, Kam S. Clinical observations of gastrointestinal cow milk allergy in children according to a new classification. Korean J Pediatr Gastroenterol Nutr 2004;7:40–47.
9. Mansueto P, Montalto G, Pacor ML, Esposito-Pellitteri M, Ditta V, Lo Bianco C, et al. Food allergy in gastroenterologic diseases: review of literature. World J Gastroenterol 2006;12:7744–7752.
10. Eigenmann PA. Mechanisms of food allergy. Pediatr Allergy Immunol 2009;20:5–11.
11. Jyonouchi H. Non-IgE mediated food allergy. Inflamm Allergy Drug Targets 2008;7:173–180.
12. Boné J, Claver A, Guallar I, Plaza AM. Allergic proctocolitis, food-induced enterocolitis: immune mechanisms, diagnosis and treatment. Allergol Immunopathol (Madr) 2009;37:36–42.
13. Chung HL, Hwang JB, Park JJ, Kim SG. Expression of transforming growth factor beta1, transforming growth factor type I and II receptors, and TNF-alpha in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol 2002;109:150–154.
14. Pratt CA, Demain JG, Rathkopf MM. Food allergy and eosinophilic gastrointestinal disorders: guiding our diagnosis and treatment. Curr Probl Pediatr Adolesc Health Care 2008;38:170–188.
15. Bischoff SC. Food allergy and eosinophilic gastroenteritis and colitis. Curr Opin Allergy Clin Immunol 2010;10:238–245.
16. Furuta GT, Forbes D, Boey C, Dupont C, Putnam P, Roy S, et al. Eosinophilic gastrointestinal diseases (EGIDs). J Pediatr Gastroenterol Nutr 2008;47:234–238.
17. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113:11–28.
quiz 9.
18. King J, Khan S. Eosinophilic esophagitis: perspectives of adult and pediatric gastroenterologists. Dig Dis Sci 2010;55:973–982.
19. Chehade M, Aceves SS. Food allergy and eosinophilic esophagitis. Curr Opin Allergy Clin Immunol 2010;10:231–237.
20. Heine RG. Allergic gastrointestinal motility disorders in infancy and early childhood. Pediatr Allergy Immunol 2008;19:383–391.
21. Son BK, Lim DH. Allergic skin test. Korean J Pediatr 2007;50:409–415.
22. Berni Canani R, Ruotolo S, Discepolo V, Troncone R. The diagnosis of food allergy in children. Curr Opin Pediatr 2008;20:584–589.
23. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342–1363.
24. Oh HE, Chetty R. Eosinophilic gastroenteritis: a review. J Gastroenterol 2008;43:741–750.
25. Nowak-Wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 2009;9:371–377.
26. Hwang JB. Food protein-induced enterocolitis syndrome: an update on clinical approaches and its pathophysiology. Korean J Pediatr Gastroenterol Nutr 2007;10:117–128.
27. Nam SY. Food allergy; diagnosis and treatment. Pediatr Allergy Respir Dis 2004;14:119–126.