PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of gutGutView this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Gut. 1996 July; 39(1): 130–135.
PMCID: PMC1383246

Double blind, placebo controlled food reactions do not correlate to IgE allergy in the diagnosis of staple food related gastrointestinal symptoms.

Abstract

BACKGROUND: The mechanisms for adverse reactions to foods in the gastrointestinal tract are poorly understood. There is conflicting evidence in the literature on the role for IgE mediated allergy in gastrointestinal reactions to staple foods. AIM: The aim was therefore to study the role of IgE mediated allergy in a group of patients with a history of gastrointestinal symptoms related to staple foods (cows' milk, hens' egg, wheat and rye flour) verified in double blind placebo controlled challenges (DBPCFC). PATIENTS: Fifteen patients with DBPCFC, identified by screening of 96 consecutive patients referred to our allergy clinic for investigation of suspected gastrointestinal symptoms due to staple foods. METHODS: The screening included diaries as well as elimination diets and open and blinded food challenges. The frequency of atopy were compared between the double blind positive and double blind negative patients. RESULTS: The positive DBPCFC in the 15 patients included eight patients with milk intolerance, four with wheat flour, two with egg, and one with rye flour. There was no indications of an allergic pathogenesis in all 15 patients with positive DBPCFC, as the skin prick test and radioallergosorbent test were negative for the relevant allergens. The frequency of atopy was four of 21 (19%) in the double blind negative group and three of 15 (20%) in the double blind positive group. CONCLUSION: In adult patients with staple food induced gastrointestinal symptoms, objectively verified by DBPCFC, there were no indications of IgE mediated allergy to the relevant foods suggesting other mechanisms in adults than in children. Future studies may include measures of local events in the shock organs in relation to food intake, for instance utilising inflammatory markers in jejunal fluids.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Feeney MC. Nutritional and dietary management of food allergy in children. Am J Clin Nutr. 1969 Jan;22(1):103–111. [PubMed]
  • David TJ, Waddington E, Stanton RH. Nutritional hazards of elimination diets in children with atopic eczema. Arch Dis Child. 1984 Apr;59(4):323–325. [PMC free article] [PubMed]
  • Roesler TA, Barry PC, Bock SA. Factitious food allergy and failure to thrive. Arch Pediatr Adolesc Med. 1994 Nov;148(11):1150–1155. [PubMed]
  • May CD. Objective clinical and laboratory studies of immediate hypersensitivity reactions to foods in asthmatic children. J Allergy Clin Immunol. 1976 Oct;58(4):500–515. [PubMed]
  • Bernstein M, Day JH, Welsh A. Double-blind food challenge in the diagnosis of food sensitivity in the adult. J Allergy Clin Immunol. 1982 Sep;70(3):205–210. [PubMed]
  • Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S, Sachs M, Bush RK, Metcalfe DD. Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. J Allergy Clin Immunol. 1988 Dec;82(6):986–997. [PubMed]
  • Bengtsson U, Rognum TP, Brandtzaeg P, Kilander A, Hansson G, Ahlstedt S, Hanson LA. IgE-positive duodenal mast cells in patients with food-related diarrhea. Int Arch Allergy Appl Immunol. 1991;95(1):86–91. [PubMed]
  • Aas K, Backman A, Belin L, Weeke B. Standardization of allergen extracts with appropriate methods. The combined use of skin prick testing and radio-allergosorbent tests. Allergy. 1978 Jun;33(3):130–137. [PubMed]
  • Farah DA, Calder I, Benson L, MacKenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut. 1985 Feb;26(2):164–168. [PMC free article] [PubMed]
  • Atkins FM. A critical evaluation of clinical trials in adverse reactions to foods in adults. J Allergy Clin Immunol. 1986 Jul;78(1 Pt 2):174–182. [PubMed]
  • Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 1984 Jul;74(1):26–33. [PubMed]
  • Sampson HA. IgE-mediated food intolerance. J Allergy Clin Immunol. 1988 Mar;81(3):495–504. [PubMed]
  • Atkins FM, Steinberg SS, Metcalfe DD. Evaluation of immediate adverse reactions to foods in adult patients. I. Correlation of demographic, laboratory, and prick skin test data with response to controlled oral food challenge. J Allergy Clin Immunol. 1985 Mar;75(3):348–355. [PubMed]
  • Valenta R, Duchene M, Ebner C, Valent P, Sillaber C, Deviller P, Ferreira F, Tejkl M, Edelmann H, Kraft D, et al. Profilins constitute a novel family of functional plant pan-allergens. J Exp Med. 1992 Feb 1;175(2):377–385. [PMC free article] [PubMed]
  • Brandtzaeg P. Research in gastrointestinal immunology. State of the art. Scand J Gastroenterol Suppl. 1985;114:137–156. [PubMed]
  • Kolmannskog S, Haneberg B. Immunoglobulin E in feces from children with allergy. Evidence of local production of IgE in the gut. Int Arch Allergy Appl Immunol. 1985;76(2):133–137. [PubMed]
  • Reimann HJ, Lewin J. Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol. 1988 Nov;83(11):1212–1219. [PubMed]
  • Woodbury RG, Miller HR, Huntley JF, Newlands GF, Palliser AC, Wakelin D. Mucosal mast cells are functionally active during spontaneous expulsion of intestinal nematode infections in rat. Nature. 312(5993):450–452. [PubMed]
  • Saalman R, Carlsson B, Fällström SP, Hanson LA, Ahlstedt S. Antibody-dependent cell-mediated cytotoxicity to beta-lactoglobulin-coated cells with sera from children with intolerance of cow's milk protein. Clin Exp Immunol. 1991 Sep;85(3):446–452. [PubMed]
  • Paganelli R, Cavagni G, Pallone F. The role of antigenic absorption and circulating immune complexes in food allergy. Ann Allergy. 1986 Nov;57(5):330–336. [PubMed]
  • Ferguson A, Mowat AM, Strobel S, Barnetson RS. T-cell mediated immunity in food allergy. Ann Allergy. 1983 Aug;51(2 Pt 2):246–248. [PubMed]
  • Bengtsson U, Knutson TW, Knutson L, Dannaeus A, Hällgren R, Ahlstedt S. Increased levels of hyaluronan and albumin after intestinal challenge in adult patients with cow's milk intolerance. Clin Exp Allergy. 1996 Jan;26(1):96–103. [PubMed]
  • Knutson TW, Bengtsson U, Dannaeus A, Ahlstedt S, Stålenheim G, Hällgren R, Knutson L. Intestinal reactivity in allergic and nonallergic patients: an approach to determine the complexity of the mucosal reaction. J Allergy Clin Immunol. 1993 Feb;91(2):553–559. [PubMed]
  • Svedlund J, Sjödin I, Dotevall G, Gillberg R. Upper gastrointestinal and mental symptoms in the irritable bowel syndrome. Scand J Gastroenterol. 1985 Jun;20(5):595–601. [PubMed]
  • Jones VA, McLaughlan P, Shorthouse M, Workman E, Hunter JO. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet. 1982 Nov 20;2(8308):1115–1117. [PubMed]
  • Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet. 1983 Aug 6;2(8345):295–297. [PubMed]
  • Nanda R, James R, Smith H, Dudley CR, Jewell DP. Food intolerance and the irritable bowel syndrome. Gut. 1989 Aug;30(8):1099–1104. [PMC free article] [PubMed]
  • Rumessen JJ, Gudmand-Høyer E. Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology. 1988 Sep;95(3):694–700. [PubMed]
  • Sattler J, Häfner D, Klotter HJ, Lorenz W, Wagner PK. Food-induced histaminosis as an epidemiological problem: plasma histamine elevation and haemodynamic alterations after oral histamine administration and blockade of diamine oxidase (DAO). Agents Actions. 1988 Apr;23(3-4):361–365. [PubMed]
  • Lessof MH, Gant V, Hinuma K, Murphy GM, Dowling RH. Recurrent urticaria and reduced diamine oxidase activity. Clin Exp Allergy. 1990 Jul;20(4):373–376. [PubMed]
  • Kurek M, Przybilla B, Hermann K, Ring J. A naturally occurring opioid peptide from cow's milk, beta-casomorphine-7, is a direct histamine releaser in man. Int Arch Allergy Immunol. 1992;97(2):115–120. [PubMed]
  • Svedberg J, de Haas J, Leimenstoll G, Paul F, Teschemacher H. Demonstration of beta-casomorphin immunoreactive materials in in vitro digests of bovine milk and in small intestine contents after bovine milk ingestion in adult humans. Peptides. 1985 Sep-Oct;6(5):825–830. [PubMed]
  • MacQueen G, Marshall J, Perdue M, Siegel S, Bienenstock J. Pavlovian conditioning of rat mucosal mast cells to secrete rat mast cell protease II. Science. 1989 Jan 6;243(4887):83–85. [PubMed]
  • Stead RH, Dixon MF, Bramwell NH, Riddell RH, Bienenstock J. Mast cells are closely apposed to nerves in the human gastrointestinal mucosa. Gastroenterology. 1989 Sep;97(3):575–585. [PubMed]
  • Hide DW. Food allergy in children. Clin Exp Allergy. 1994 Jan;24(1):1–2. [PubMed]

Articles from Gut are provided here courtesy of BMJ Publishing Group