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

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

Question In your clinical experience, what is the role of food allergy and/or intolerance in the genesis of inflammatory bowel disease (IBD)?

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.