A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy

Centre for Paediatric Gastroenterology and Department of Dietetics and Histopathology, Royal Free and University College School of Medicine, London, United Kingdom.
Journal of Pediatrics (Impact Factor: 3.74). 08/2003; 143(1):39-47. DOI: 10.1016/S0022-3476(03)00193-8
Source: PubMed

ABSTRACT Although immunoglobulin (Ig)E-mediated allergies are readily identifiable, non-IgE-mediated allergies present more diagnostic difficulty. We performed a formal retrospective analysis to determine whether there is a recognizable clinical pattern in children.
We studied 121 children (mean age, 17.3 months) with multiple food allergies who were recruited on the basis of adequate immunological assessment by using case notes and parental questionnaire.
Group 1 (n=44) had rapid reactions to dietary antigens, of whom 41 also showed delayed reactions. Group 2 (n=77) had delayed reactions only. Mean IgE was increased in group 1 but both groups otherwise shared a pattern of increased IgG1, decreased IgG2/4, and low-normal IgA. Lymphocyte subsets were skewed, with an increased percentage of CD4 and CD19 and decreased CD8 and natural killer cells. Gastroesophageal reflux, esophagitis, subtle enteropathy, and constipation were frequent in both groups. Of 55 exclusively breast-fed infants, 44 sensitized before weaning. Twenty-one of the mothers suffered from autoimmunity.
There appears to be a recognizable pattern of immune deviation and minor enteropathy in children with multiple food allergy, irrespective of the speed of reactions. Disturbed gut motility is particularly common, as is a maternal history of autoimmunity.


Available from: Simon H Murch, Sep 04, 2014
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    ABSTRACT: Food allergy is a common problem in childhood. The term is used to include both immunoglobulin E (IgE)-mediated and non-IgE-mediated food allergies, which have a significant effect on the quality of life of patients and their families. In this report, we aim to discuss recent advances in the diagnosis, management, and treatment modalities of food allergy in children.
    01/2015; 7:35. DOI:10.12703/P7-35
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    ABSTRACT: Introduction Antibody production defects may predispose children to inflammatory pathologies and therefore we hypothesized that this group of immune deficiencies may be associated with food allergy. Objective of the study To better characterize the interrelated pathomechanisms of food allergy coexisting with hypogammaglobulinemia in children and to define the relationship between clinical manifestation of antibody production defects and food allergy. Material and methods Twenty-three children aged from 8 to 88 months regularly followed-up in the pediatric pneumonology, allergology and immunology clinic due to hypogammaglobulinemia concerning one or more major immunoglobulin isotypes were retrospectively reviewed in terms of incidence and manifestation of concomitant food allergy. Information regarding the patient's history of allergic diseases and laboratory data concerning serum levels of immunoglobulins, including total IgE, were obtained from chart review. Results Clinical symptoms of food allergy were identified in 17 of 23 (74%) children studied. The mean age of onset of clinical symptoms was 2.7 months. Eczema was the most frequent manifestation present in 16 children, diarrheas and abdominal cramps were noted equally in 3 children, gastroesophageal reflux disease was diagnosed in 2 children as well as vomiting was observed in 2 children. Atopy was revealed in 8 of 17 children (47%) with food allergy. Conclusions Food allergy is a common health problem coexisting with antibody production defects in infants and young children. Clinical symptoms correlate better with low immunoglobulin levels than with serum IgE, that is not a suitable diagnostic criterion for allergic disease in patients with hypogammaglobulinemia.
    Pediatria polska 10/2012; 87(5):444–448. DOI:10.1016/j.pepo.2012.07.004