What Is the Role of Food Allergy and/or Intolerance in the Genesis of IBD?

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What Is the Role of Food Allergy and/or Intolerance in the Genesis of IBD?

http://www.medscape.com/viewarticle/522393?src=mp

Question

In your clinical experience, what is the role of food allergy and/or

intolerance in the genesis of inflammatory bowel disease (IBD)?

Expert Response from Sunanda V. Kane, MD, MSPH, FACG

Associate Professor of Medicine, Pritzker School of Medicine, Chicago,

Illinois; Assistant Professor of Medicine, Section of Gastroenterology

and Nutrition, Department of Medicine, University of Chicago, Chicago,

Illinois; University of Chicago Hospitals, Chicago, Illinois

True food allergies constitute a different pathogenesis and pathology

from true IBD. Although the true cause of IBD remains elusive, it

appears to involve a combination of genetic susceptibility, immune

dysregulation, and environmental pressures. Patients with IBD are more

likely to suffer from food allergies or intolerances than the normal

population, but there is not good evidence to suggest that an allergy is

the trigger for the underlying inflammatory process. Whereas some groups

have been able to demonstrate immune responses to certain food antigens

in patients with Crohn's disease, these findings cannot be replicated in

other populations, making this mechanism for a pathogenesis unlikely. In

patients with subclinical disease, an allergy can precipitate IBD

phenotypes, but again, the link between allergies and causation is weak.

Certainly those patients who have undiagnosed food intolerances are less

likely to respond to standard IBD therapies.

Patients should be counseled regarding their dietary habits to monitor

which specific foods or food groups may trigger worse gastrointestinal

or systemic symptoms. Elimination diets, however, are rarely needed in

the IBD patient.

Posted 02/07/2006

Suggested Readings

* Huber A, Genser D, Spitzauer S, et al. IgE/anti-IgE immune

complexes in sera from patients with Crohn's disease do not contain

food-specific IgE. Int Arch Allergy Immunol. 1998;115:67-72.

* Mantzaris GJ, Roussos A, Koilakou S, et al. Prevalence of celiac

disease in patients with Crohn's disease. Inflamm Bowel Dis. 2005;11:1029.

* Van Den Bogaerde J, Cahill J, Emmanuel AV, et al. Gut mucosal

response to food antigens in Crohn's disease. Aliment Pharmacol Ther.

2002;16:1903-1915.

Disclosure: Sunanda V. Kane, MD, MSPH, FACG, has disclosed that she has

received research support or funding from Procter & Gamble, Salix, and

GlaxoKline. Dr. Kane has also disclosed that she has served as a

consultant to Aventis, Centocor, Elan, Ferring, Nisshin-Kyorin

Pharmaceuticals, Procter & Gamble, Shire, TAP Pharmaceuticals, and UCB,

and has served on the speaker's bureau for Abbott, AstraZeneca,

Centocor, GlaxoKline, Novartis, Procter & Gamble, Prometheus,

Salix, Shire, Solvay, and TAP Pharmaceuticals.

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