[PHNUTR-L] What Is the Role of Food Allergy and/or Intolerance in
the Genesis of IBD?
Kathrynne Holden, MS, RD
fivestar at nutritionucanlivewith.com
Tue Feb 14 14:53:50 PST 2006
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What Is the Role of Food Allergy and/or Intolerance in the Genesis of IBD?
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.
* 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.
Disclosure: Sunanda V. Kane, MD, MSPH, FACG, has disclosed that she has
received research support or funding from Procter & Gamble, Salix, and
GlaxoSmithKline. 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, GlaxoSmithKline, Novartis, Procter & Gamble, Prometheus,
Salix, Shire, Solvay, and TAP Pharmaceuticals.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian" http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
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