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

Lee: The Diagnosis of Food Allergy in a Pediatric Gastroenterology: Focusing on Non-IgE-mediated Allergic Diseases


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.

Figures and Tables

Fig. 1
Evaluation of a child with suspected food allergy.
Fig. 2
Measurement for skin prick test.
Fig. 3
Procedures for diagnosis of eosinophilic esophagitis.
Fig. 4
Algorithm after oral cow's milk challenge for diagnosis of typical cow's milk protein-induced enterocolitis. Adapted from ref. 26.
Fig. 5
Selection of type of food challenge according to age and symptoms. Adapted from ref. 22.
Table 1
Classification of Gastrointestinal Hypersensitivities to Food and Other Dietary Products
Table 2
The Seven Groups of Gastrointestinal Cow Milk Allergy in Infants
Table 3
Principal Characteristics of Allergic Proctocolitis

Adapted from Pediatr Allergy Immunol 2007;18:360-7.

Table 4
Principal Characteristics of Food-Induced Enterocolitis Syndrome

Adapted from Pediatr Allergy Immunol 2007;18:360-7.

Table 5
Most common Age-Related Clinical Manifestations of EOE

EoE: eosinophilic esophagitis, GERD: gastroesophageal reflux disease.

Table 6
Classification of Eosinophilic Gastroenteritis

Adapted from Curr Oprin Allegy Clin Immunol 2010;10:238-45.

Table 7
Major Symptoms of Eosinophilic Gastroenteritis Depending on the Localization of Disease

EoE: eosinophilic esophagitis. Adapted from Curr Oprin Allegy Clin Immunol 2010;10:238-45.

Table 8
Clinical Features Suggestive of Food Protein-Induced Gastrointestinal Motility Disorders In Infants and Young Children

Adapted from Pediatr Allergy Immunol 2008;19:383-91.

Table 9
Grading System for Skin Prick Test

A: allergen, H: histamine, R: ratio of wheal of allergen and histamine (1 mg/ml). Adapted from ref. 21.

Table 10
Predictive Values of Food Allergen-Specific Immunoglobulin E Levels

PL: prodictive level, PPV: positive predictive value. *Infants<2 years. Adapted from ref. 22.

Table 11
Diagnostic Guideline of Esosinophilic Esophagitis

Adapted from ref. 23.

Table 12
Histologic Features Associated with EE

None of the features are pathognomonic of EE. Adapted from ref. 23.

Table 13
Oral food challenge in food protein-induced enterocolitis syndrome

*Lower dose recommended in children with history of previous severe reaction. Adapted from ref. 25.


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